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I�RMIT APPLICATI'�iN <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 TAX I.D.N PERMiT M <br /> e2� CASrNo i2'7 . �' L o�S 9P �mo•70.�/�/ S C�.?o3-Oo <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADOFESS Z�P PHONE <br /> LrV�`R�.-tT �nl�crtw��T, ��9 c� c�.,.�v 2� t�n�l'f-� w•fi ^s�ZeY <br /> TENANTNAME CONTACTNAME PHONE <br /> �IrT/�//1�'� ; �r_-7_! H-t)eNU O a 4ts .2'i � ,1.�4 0 <br /> C/O�N/�TRACTOR AODRESS ZIP CONTR.UCENSE N <br /> 'j�l�sI�FIJf:n.Vl(rT � icz�z �o;,,� rr���rrN4•j �Fz�s 8�3TsIs �9q�F�' <br /> aHyit 33�,(�/GO �/LL ('��1=-7C� h��' J�n/ 2-- <br /> PROPOSED USfl OF BUILOING pERM1T R�..( Com6i alion PIum6 nga1 W�RK B Rep e/Mainl. HEAT SE eRCE <br /> ��'/ ��� TVPE �../ DemO�ilion �'Slgn 7YPE New �] Gas <br /> � U Sprinkler L� Other <br /> CONTRACT PRICE OF WORK r-�' 6� � CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK OESCAIPTION <br /> j.t/II,�;cc a+r.i�• -2 ' Xlc+� f'�f Sib.t/ �'.q.tini�;'r q•.'9 /-f�c„l= ✓/ 70 <br /> c= x rr , ���F Fo..,�r< <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TUFE OR REM NO. TYPE OF FI%TURE OR R'EM <br /> � WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> , DISHWASHER FANGE HOOD <br /> LAUNORY TRAY WATER HEATER <br /> I _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URiNAL _ FIREPLACE INSERT <br /> i _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> ' FLOOR DRAIN GAS fiAN(3E <br /> BACKFLON' PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOPlETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBV CERITIFV' I HAVE REAO AND EXAMINED THIS APPI.ICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALl <br /> PROVISIONS OF 5 AaD ORIDINACES GOVERNING TfiIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRANj NG OF A PERMIT�OES NOT PRESUME TO GIVF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIO!J OF ANY OTHER <br /> 51ATE OR LOCAC LAW REGULATING CONSTRUCTION OP THE PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY'''///T,,,O PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1 27 rµ,W AND 296200 WAC. - <br /> a, <br /> r U���• , �, <br /> SignaWreol wnevContractor/ ulh nzedAgent <br /> YL <br />