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P�("'MI� APPLICATIO.' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> .� r+/� 425•257-8810 - FAX 425•257-8857 <br /> (J Or,v �09- 30 <br /> SITE ADDRESS /� PAqCEL TAX I.D.N PERMIT M <br /> ��L/!s r c�4s.,va �,p� o '� Q�39 60 0 3o i o0o I C ON O �-OZJe <br /> LEGA LUTNO. BLOCK TRACT <br /> oES�. z S�'� eort" o <br /> OWNER '3- d�� <br /> /� ADDRESS LP PMONE <br /> /`7it�fAtZ �4�,.e.p:�s �f O /�ru �� UuvA� /✓,0 /��/9 �?-�d�Sl/j• �`/i3 <br /> TENANT NAME I CONTACT NAME PHONE <br /> CONTRAG70R DD ES3 <br /> ��`��1-�=����� ��q�� �v�µ `� P�ZIP CONTR.^ICENSyF�I <br /> � .Y / �c.4'Cr.Q(../��V r <br /> PHONE <br /> i3 <br /> FROPOSED USE OF BUILDINO p� Bullding � Mechanical n Adtlillon HEAT 90UHCE <br /> i PERMIT �f_� Combination Plum6ing WOpK �� nt�eretion � E�nctric <br /> ���z TYPE �_� Demolillon Sign IYPE {�� New Qes <br /> LJ Sprinkler LJ RepalriMaim. Other <br /> I CONTRACT PqICE OF WORK �� O� ` / �/ >��" CITY OF EVERETT LOCAL SALES 7AX CODE IS J106 <br /> � WORK DESCRIPTION / <br /> I /�/vtJ �,JOo� f-R-�ON�i.'� �Nl�CiS' /�J7.N��,' /�i?SiaGM"G <br /> i _ / i� , �; � r �lT-� ��. �� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF fll(TURE OR ITEM <br /> I <br /> ' WATEt7 CLOuET <br /> ' � OATHTLIB aC-A/FIANDLING UNITS <br /> � � - � FORCED AIF SYSTEMS <br /> ; L LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � � SHOWER UNIT HEATERS <br /> � � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> _ DISHWA5NER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> Z CLOTHES WASHER A METALFiREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLOOR DRA�N O�S RANGE <br /> _ BACKFLON �REVENTER � GAS PIPING r <br /> _ SINK(SEhVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER <br /> _ OTHER <br /> I HEREBY CERIiIFV THAT I HAVE READ AND E�AMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMI7 DOES NOT PqESUME TO GIVE AUTHORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY OTHEH <br /> STATE OR LO REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTFUCTION. THAT I AM AUTNORIZED UY THE <br /> OWI�ER OF THIS P PERTY TO PERFJRM THE WORM FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONTRACTORS �10,�7 RC�y�2g6. 0 WAC. <br /> / /� /I <br /> l4 � � �n � s-�� <br /> Signalure ol Owneri ontractor/ uthonzed Agent ate <br /> �IL <br /> SC z� <br />