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P�;RMIT APPLICATI� �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - F.4X 425-257-8857 <br /> i SITE ADDRFSS PARCEL TAX I.D.N PERMIT M <br /> , /f,C��i 6 �.4s�,v�� r'b�3936c�rv.<;a«�z I C:v3cq-GZ8' <br /> IEGA LOT N0. BLOCK TRACT � <br /> oesc. � Sa O/•c>3d NcJ'�,�m•,�(�J�y�.�'c: ,7+ Ti.x1�S.•! �.4.�bE S� !JH <br /> I OWNER � ADDRE55 21P PHOfrF. <br /> �c..v.rEz �iQ.r� �. �'�sx 3� �i. uvA�;/,.�A �fGv9 (z�b/9-��is <br /> I TENANT NAME I COhTACT NAME PHONE <br /> iCONTRACTOH �' / ADDRESS �5�p Q CONTA.UCENSE N <br /> � l�c.ci�Ayi'(�.hiX�.c.�lc�/,[K, /��/�' 7x 'bo'Z���y b'. <br /> I PHONE �L✓E�Q�,'L g�lo✓ T <br /> I �2ob� &/9- ��fi3 EU�e.: �.c'K 033t�9� <br /> PROPOSED USE OF BUILDING I Building Mechanlcel Addition HEA'SOUPCE <br /> ; � � PERMIT � Combinalion� Plumbing WORK �Allorellon � ElecLk <br /> S/„��,c6 ,,,�,c.....� t�$ TYPE De!^^!'lion U Sign TYPE New Ges <br /> I Sprnkler Rapair/Main1. O�her <br /> � CONTRACT PRICE OF WORK �OO� CITY OF EVERETT LOCAL SALES TAX CODE 19 3105 <br /> i V <br /> I WORK DESCRIPTION <br /> � �� l�a /-1�A,w� .�.��2 - �ASiG 'y �Z o3� <br /> � PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM NO. TVPE OF FlXTURE OR REM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> � tlATHTUB � FORCED Alfi SYSTEMS <br /> _I LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISIiWASHER —T P,,�NGE HOOD <br /> LAUNDRV TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIFEPLACE/STOVE <br /> URINAL FiREPLACE INSERT <br /> DRINKING FOUNTAIN / GAS FIREPLACE <br /> _ FLOOF �RAIN � GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE.�BARiMOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER <br /> i HERE9v CEaiTiFY'HnT i HAVE READ AND EXANINED THIS APPUCATION AND NNOW THE SAME TO BE T(iUE AND CORRECT. ALL <br /> PPOVISIOt1$CF W WS PND OHIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEfiEIN OR <br /> NOT THE GPa��TI��G OF n PEP�d1T DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCA LAW REGUV+'ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTNORIZED BV THE <br /> OWNER OF iHi PERTY 70 PERFORM THE WOPK FOFi WNICH APPLICATION IS MADE AND I COMP�Y WITH THE STATE <br /> CONTRACTOP.S 18. R AND296 j�AC <br /> �' ��.��(_ � /Fr-03 <br /> SignaWrn ol ONnen onlracmuAu�honzed Agenl ate �� <br />