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� � NERMIT APPLICA�ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TA%I.D.1 <br /> �D�1 E� C�"�/NO /L�. 7d j �� PERMIT N <br /> r 'F �Jou000 %�� 2 z 't�0 <br /> LEaA LOT N0. , BLOCK TRACT <br /> DESC. <br /> OWNER ADDREF3 <br /> ZIP PNONE <br /> �y`"`n'�T— '�✓�c"T"�.+,r�v! ��e . ?fi9 e.�,rr•.�� k.�. e v�-acy-r_ (z o�� <br /> TENANTNAME -� - w�• 9'��'"'/ ��'� ���' - <br /> CON70.CTNAME PHONE <br /> G.A�;o R- ,<'GA�`j .�i•�. </Z T. G a z .2�oe/ <br /> CONTAACTOR ADORESS <br /> ��.��% i/(,v S �-rlv/[� T �L Z/2 3�-�L-E V�72t-n� �fv,�P CONTR.UCENSE I <br /> PHONE q �Z�, J <br /> 'Y2f• s"7J_d'�6o r��i�C tR�'t�C, 4,/`�iL. 3���S�S99�°4' <br /> PHOPOSED USE OF BUILDINO Bullding Mec';anlcal <br /> Addltion HEA7 SOURCE <br /> PERMIT Combinetlon R Plumbing WOqK �Allere�lon <br /> TYPE Damolillan ���• Electrlc <br /> 9�SIgn TYPE irew Oaa <br /> Sprinkler Repelr/Melnt. Other <br /> CONTRACT PRICE OF WORK h`/,,�U CITY OF EVERETT IOCAL SALES TA%COOE 19 0/06 <br /> WORK DESCRIPTION , <br /> j��.rT.t+>c ^�F 3�� ' ac / � ' S,.�GG c'' /�rcc� .ri�✓. <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM <br /> NO. TYpE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ q/C-A/HANDLIN6 UNITS <br /> _ BATHTUB <br /> _ LAVATOFY(WASH BASIN) — FORCED AIR SYSTEMS <br /> _ SHOWER _ HEl1T PUMP <br /> _ KITCHEN SINK 8 DISPOSAL — UNIT HEATERS <br /> _ DISHWASHER — CLOTHES DRYER <br /> _ LAUNDRYTRAY — RANOE HOOD <br /> _ CLOTHES WASHER — WATER HEATER <br /> _ URINAL — METAL FIREPLACE/STOVE <br /> _ DRINKING FOUNTAIN — FIREPLACE INSER7 <br /> __ FLOOR DRAIN —. QAS FIREPLACE <br /> _ BACKFLOW PREVENTER — GAS RAN(iE <br /> _ SINK(SERVICElBAR/MOP/ETC.) — GAS PIPING <br /> ._ OTHER _ EXHAUSTFAN <br /> ._ OTHER <br /> II HFREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS ApPLICATION AND KNOW THE SAME TO UE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NO7. THE GRANTING OF A PERMIT�OES N07 PRESUME TO GIVE AUTHOAITV TO VIOLATE OH CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING GONSTRUCT�ON OR TNE PERFOFMANCE OF CONSTRUCTIUN. THAT I AM AU7HORIZED BY THE <br /> OWNER OF THIS PROPERTV 10 PERFORM THE WONK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAGTORS LAW ig27 RCW AND 296.200 WAC. <br /> --�--=� � ti � / Z z /o t <br /> Signatur6 oYOwnedCon aciov,qu�nonzed Agenl ' ate <br /> � L <br />