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( <br /> aCRIVIIT APPLICATI(..�� <br /> �� CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> S��DHESS ���1 �(_� (�� PAHCEL TAX I.D.N PERMIT p n _� <br /> f� c� <br /> IEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> ��ER �-- ADDRESS 1�1u(�I � PHONE <br /> ,C� � I�..�,'�- '� 1�'1U�1 l��l�' �b�k w v�Na ' � <br /> TE�ANT NAME CONTACT NAME ' PHONE <br /> u�n �P��r I i <br /> CONTR C OR ADDRESS I CONTR. LICENSE� <br /> ��1V�1U'U� �iz �Pro c �� � � �z-� � '�nm���3zmr� <br /> ' � q�z7 <br /> oN , � �� -qC� �t�e.r n�,r �; <br /> PROPOSED USE OF BUILDING Builtling n M••�hanical Addition HEAT SOURCE I <br /> PERMIT Combination ❑ Plumbing WORK �Aitera�ion D Electnc <br /> TYPE �_Demolition � Sign TYPE New D Gas <br /> ,$prinkler RepairrMaint. L� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT IOCAL SALES TAX COOE IS J105 <br /> WORK DE CRIPTION ���� �(� � ,�� ^ ,.�/ I��— �� S �p ,_ _ <br /> o' � I� J`'; �1�"�' \ <br /> ��� <br /> �L I�MBING h�EC�HANI1CA_L <br /> N0. TVPE OF FIXTURE OF ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITo <br /> �ATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATCRS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES OFVER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS FANGE <br /> � BACKFLOW PREVENTER GAS PIPI�� ���j <br /> SINK (SERVICE:BAR/610P.'ETC.) EXHAUST <br /> = OTHER__ — � OTHER I <br /> --- — � <br /> I HEREBY CEqITIFV THAT I MAVE READ 4ND EXAh11NED THIS APPLICATION AND KNOYJ THE SAh1E TC BE TRUE AND CORRECT ALL � <br /> iPROVISIONS OF L4WS ANU ORIDINACES GOVERMNG THIS TYPE OF WORK 4V4L BE COM1IPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> N07 THE GPA471NG OF A PERMIT DOES NOT PRESUAfE TO GIVE AUTHORITY TO VIGIATE OR CANCEL THE PFOVISION OF ANV OTHEH <br /> � STATE OR LOCAL LASV REGULATING CONSTPUCTION OR THE PERFOPh1ANCE OF CONSTRUCTION THAT I AM AUTHOFIZED BY THE I <br /> � OWNFj1 0 11S PROPERN TO PEFFORM1I THE WOFK FOR WHICH APPLICATION IS h1ADE AND I C061PLV WITH THE STATE <br /> CONTbAC70 LA�Y 1 A 2' C AND 296 2C0 WAC I <br /> ( � � '' � r"�'� �,� 12 � 2� �� <br /> Signalure o i ner ConlractouAuthonzed Agent Date �/� <br /> Y � <br />