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I . _ _ . . __ . _--_._._—___ i <br /> � PE; ;VIIT APPLICATIC�� ' <br /> ��, CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 � <br /> SITE ADDRESS ,� ` I V PARCEL TAX I.D.M PEanniT a ' <br /> 3-� ?3.�a�oc��Ay, ����cr � OOy373y25vo � 0�66 Cl� <br /> LEGA L0T NO. rl/A BLOCK TRACT � I <br /> I DESC. <br /> OWNEq ADDRESS ZIP PHONE <br /> I �'f�/+�llT 3G0 NDli7iiL'G:S' 27/7 �'OC�tErClGE�c' /Jvf 982�1 �125�2/2-2ZID <br /> ITENANT NAME N CONTACT NAME PHOIJE ! <br /> � �iq I �ONATNA�✓ ��/G iAn/ �/l5�</�3 5!5 7 i <br /> CONTRACTOR �Di'ANCL-!J f�QE O�OTL'Ci/ON ADDFESS ZIP CONTH.LIGENSE N ' <br /> �n. �oX �sy3 9,�o�z �o��A,�F�,9y�E i <br /> PHGNG �:Jl$) '��3_SCS7 <br /> � PROPOSED USE OF BUILDING 8ui�dins MeChaniCal Adtlition HEAT SOURCE ' <br /> i PERMIT �Combination R Plumbing WORK � Alleration (� Electric j <br /> I ixC-�) U5C �'EtAc av.�zp��✓i; D Sign rvae New Gas <br /> M TYPE Demolitiun <br />� Sprinklel Repair/IAaiN. Other i <br /> CONTRACT PRICE OF WOHK����9�S GTY OF EVERETT LOCAL SALES TAX COOE�5 3105 <br />� WORK DESCRIPTIDN I <br /> N�/ S���N�l6�C' SY.STFM INSiAC[A�/On� �!�`� S�rrnKlfi he��S� � <br /> I <br /> PLUMBING MECHANICAL i <br /> NO. TYPE OF FIXTURE OF ITEM N0. TYPE OF FIXTURE OR ITEM I <br /> WATER CLOS[T A/C —A/HANDLING UNITS � � <br /> _ �ATHTUB FORCED AIR 5'ISTEMS <br /> _ �AVATORY(WASH LiA51N) HEAT PUMP �� , <br /> SHOWER UNIT HEATERS ' <br /> KITCHEN SINK& DISPOSA� CLOTHES DRYER <br /> DISHWASHER RANGE HOOD I <br /> _ LAUNDRYTRAY _ WATER HEATER <br /> i CLOTHES WASHER METAL FIREPLACEiSTOVE <br /> _ URINA� FIREPLACE INSERT I <br /> DRItJKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RANGE i <br /> BACKFLOW PREVENTER GAS PIPWG ' ' <br /> SiNK (SEFVICE/BAR/MOP/ETC.) EXHAUST FA�J I <br /> _ OTHER OTHER , <br /> i <br /> i HEREBY CERITIFY'HAT I HAVE RGtiD AN�EXAIdINED THIS APPLICATIOtJ AND KI�GW THE SAME TO BE TPUE APJD CORRECT. ALL � <br /> PpOVISIONS OF LAWS ANO ORIGINACES GU'dE9NING THIS 1YPE OF WORK WILL BE COMPUED SVITM'lJHETHER SPEqFIED HEFEIN OR <br /> FIOT. THE GPAFITi�JG OF A PERI/IT DOES tJUT PRESUh1E TO GIVE AUTHORITY TO'JIOLATE OR CANCEL THG PfiO'JISION OF ANY OTHER . <br /> STA7e OR LOCAL LAW REGULATIWG CONSTRUCTIOIJ OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AI.1 AUTHOFIZED BY THE �� <br /> OWNER GF TN�S PROPEP�IY TO PERFORM THE lh'ORK�GR WHICH APPLICATIOtJ IS ldADE AND I COIAPL'!WITH THE STATE � <br /> CONTRACTORS LA N tB.27 RCW AND<"96200 VJAC � ' <br /> � Q/JG��1GA /"�i��Q i7 i i� ��'�.3-�� <br /> Signalure ol wnedComractoriAuthorrzed A t Date <br />