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i --- <br /> � <br /> P�cRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> ,�: ��'✓< G �� 3 -C�5 <br /> SITE A�DRES PARC L TAX 1.�.M PERMIT n <br /> �t 5� 5 ����� eN �i r_ c�o �3� 8� �' ol 20 :� ., , ;-� <br /> LEGA LOT Nq, BLOCK TRACT y� ' I <br /> DESC. AST 73��a ^L 12 (p P� A I O� E'U��`�� DI V , I <br /> OWNE AODRESS ZIP PHONE <br /> 2 0 ��►r; C�, ��p n iix� ��x 7 � � �ut�2�"rr �i 2�20� �Zs� zs� � � <br /> j TENANTNAME CONTACTFORPERMIT PHONE <br /> — �.I � � no �,�ni L�, �1�oR� ��E �z�� zaz _�s <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> PHONE �ID I lL- �� ( I`J,�� <br /> l / <br /> � PROPOSEU USE OF BUILOING J Y,eT,f Building � MechaniCal 1��4dditian HEAT SOURCE <br /> � ,l U �( I T ,�,,,�U ��,y PERMIT 1 ) Combinatlon Plumbing WORK B(Allerallon I $LEIecMc <br /> �/"� /I TYPE ❑ Demolition Sign TVPE D New D Gas <br /> � D Sprinkler U RepairlMaint. D Olher <br /> � CONTRACT PRICE OF WORK ,�--(���� �j�',CZ`�� CITY OF EVERETT LOCAL SALES TA%COOE 13 7705 <br /> � WORK DESCRIPTION C�O� ��� �T R�`��, � C)� �CIS I � �s `.'� <br /> "p��� LC=x`�`, i +�"lz.; s�r�.�Oio� Pq�2�v�r�NTS V��1K� ►�� <br /> L - `T R � Pc=kcS o N E `T'�x Pa r�c�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%NRE OR ITEM <br /> � � WATER CLOSET(TOILET) _ A/C—AlHANDLING UNITS <br /> — BATHTUB FORCED AIR SYSTEMS <br /> J "> LAVATORY(WASH BASIN) HEAT PUMP <br /> ! � SHOWER �� UNITHEATERS <br /> !/ �.r� KITCHEN SINK 8 DISPOSAL � CLOTHES DRYERC��� <br /> � � DISHWASHER � � RANGEHO00 � <br /> LAUNDRY TRAY WATER HEATER <br /> � _ CLOTHES WASHER � _ METAL FIREPIACE/STOVE <br /> _ URINAL FIREPLACE INSERT ^ I <br /> = DRINKING FOUNTAIN GAS FIREPLACE '1 ` � <br /> FLOOR DRAIN GAS RANGE \ 1; <br /> BACKFLOW PREVENTER GAS PIPING v <br /> _ SINK(SERVICE,rBAR/MOP.�ETC.) L� EXHAUST FAN <br /> __ OTHER � OTHER ' <br /> � HERE9V IFV THAT I HAVE READ AND E.tAMINED TMiS APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT. ALL i <br /> PRCViS S O WS AND ORiDiNACES GOVERNING THIS TVPE OF WORK�VILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> :'JpT i'hE GiiqN ING CF FftM1T DOES NOT PRESU�IE TO GIVE AUTHORITY TO ViOLATE OR CANCEL THE PROVISION OF ANV OTHER I <br /> STAT.E OR LO ..i�l'J �U G C NSTRUCT N OR THE PERFCRMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br /> OWNEf#OF' P 0 F,R7Y 0 P RM THE� RK FOR WHICH APPLIGATION 1 MADE AND I COMPIY WITH THE STATE �I <br /> CONT S ..� C' 96.<00 W � <br /> / <br /> ,� J � �LtL ,� � d C� I <br /> i at re of OwneuComr tonAuthonzoa A�lnt Dat <br /> DEBIT 8 CREUIT CARDS ARE NOT ACCEPTED '1Z I <br />