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—� — - - <br /> P'�RMIT APPLICATIUN lo `�� ,�3 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��G'/ (�_>/C� ���`� <br /> 425-257-8810— FAX 425-257-8857 <br /> La `B��G� - I;G� 7 <br /> SITE ADDRESS PARCEL TAX I.D.M PERM�T M <br /> . � - i: �L� �.r 1 i, �� y,!+_. �. .�. — � � _ <br /> LE6A LOTNO. BLOCK TRACT <br /> DESC � '. .-i� � ,t_'. . . r-�'�:' � . .�;, •��. 1�:C_ I <br /> OWNER ` 3/ // ADD, 'S PA�I�� fZO. L.-YNIWoeUZ�i�I� 9�p�7 <br /> �-- , <br /> f L-�; 4 ;' _. ;. j � , tiv, �.'_J����I���'� <p�J S�/ c �;,� � <br /> �TENANT NAME - I CONTACT NAME P nONE <br /> (4Z5�33o - ��ra <br /> CONTRACTOR AD[7RESS ZIP�y CONTR.UCENSE N <br /> /�'.d- ,� r�"',�,�+-.-.�-. /y , , . /J ! (.� ,'�';i' ''. . .:�; A :� ' 1��/�/ <br /> PHON <br /> inn��c� �1���,�„ i y',� ' � " <br /> PROPOSED USE Of BUILDING uilding f� Mechen�cal Additio� HEAT SOURCE <br /> PERMIT �ombinelion F_� Plumbing WORK R Alteretbn D ElectAc <br /> � TYPE Demolilion LJ Sign IYPE D New U Gas <br /> Sprinkler U RepelUMelnL U Other <br /> CONTRACT PRICE Of WORK CITV OF EVERETT LOCAL SALES TA%COUE IS 3/05 <br /> WORR DESCRIPTION . ; ' . . . , . . . //.�' � ' . . . , • . .. <br /> . , . , �. . . . . . . , • � � 1 <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. TVPE OF Fl%TURE OH REM <br /> WATER CLOSET A�C -A/HANDLiNt3 UNiTS <br /> B�l'HTUD FORCFD AIR SYSTEMS <br /> LAVATORV (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DfiYEfl <br /> DISfiWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASH[R METAL FIREPLACE/STUVE <br /> URINAL FIFEPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREf`LACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFL�'W PREVENTER GAS PIPING <br /> . SINK(SERVICE/�ARlMOPI[TC.) _ EXHAUST FAN <br /> OTHEF OTHER <br /> �_= T� �' � �_— — yC <br /> -- � � )� �,�7.Y f <br /> I Hf_RE6V CERITIPY THAT I HAVE FEAD AND ExAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOViSIONS OF LAWS AND ORIDINAGES GOVERNING THIS NPE OF WORK WILL BE COMPIIED WITfi WHETHER SPECIFIED HEFEIN OR <br /> INOT. THF:GRAN7ING OF A PERMIT DOES NO' PR[SUME TO GIVE AUTHOFITY TO VIOLATE OR CANCFL THE PHOVISION OF ANY OTH,':R <br /> ST�TE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNEA OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPUCATION IS MADE ANO I COMPLY WITH THE STATE <br /> CONTRACTORS I AW 18?�RCW ANO 296 2(Hl WAC. <br /> i .i <br /> Signp;ure o�OwnedConiractodAutTionzed Agent � Date ' <br /> I�C <br />