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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?01 <br /> � <br /> 425-257-8810— FAX 425-257-8857 <br /> 81TE ADDRE PARCEL TAX I.D.M M pa�j�—O�{� <br /> �► �5/�vo �� . <br /> LE6A LOiNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRE88 LP PMONE <br /> 7- �[E���l TrJc� �o. 1��c �89659 �'wlu/�, �,v�4 98i38 <br /> TENANTNAME CONTACTNAME PNONE <br /> 7_ �f J�55E �oit�Fklfi� 2e,6 -�J�/-mo r/ - <br /> CONTRACTORT.7��. f�w�� �/�� AD�RES9�DZ /� 7 ZIP CJNTR,IJCENBE� <br /> 7 I�r✓_� �r� Iri �� �.���h .�• //� <br /> PNONE �� �F�I�DO� I �..7vr�/i(Y�(t/I/ ����', � . X/ZLN�7 <br /> PROPOSED USE OF BUILDINO BUlidinp MBChBniCel ��dditlon HEAT BOURCE <br /> � - � PERMIT B CPmbinetlon Plurtlbing WORK �VJ Alteratlon D Electrlc <br /> 1 �G�� L TYPE D Demollllon Sign TVPE D New L7 o■s <br /> � �Y��� U S rinkler U RepnldMalnt. U Olher <br /> CONTRACT PRICE OF WORK /Q�� %o CITV OF EVEPETT IOCAL BALES TA%CODE IB�106 <br /> WORK DESCRIPTI01: <br /> Siv 5'rAU. l��r?J��Pi .�� L/�l/� �1�M �IIEW Sl�7Z�� <br /> F9hC�FlA� To Co�lbF�/s��.1��15 � /�F, £�(�i�'Y� <br /> P UMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM N0. TYPE OF Fl)(TURE OR ITEM <br /> WATER CIOSET A/C-A/HANDLINO UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> KITCHEN SINK d DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANQE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACE/STOVE <br /> URINAL _ F�REPLACE INSERT <br /> DRINKING FOUNTAIN _ OAS FIREPLACE <br /> FLOOR DRAIN OAS RANOE <br /> BACKFLOW PREVCNTER QAS PIPIN� <br /> SINK(SERVICE/BAR/MOPlETC.) EXHAUS �AN��,� ��.� �� � �J <br /> OTHER � OTHER�?�_�62�Z�huS <br /> I HEREBV CERITIFV THAT 1 HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISiONS Of LAWS AND ORIDINACES 60VERNING THIS TVPE UF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANT 6 OF A PEPMIT DOES N07 PP.ESUME TO QIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHEH <br /> STATE OF LOC W REGULATINO CONSTRUCTION OR THE PERFORMANCE Of CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF TH P OPERTY TO PERFOHM THE WOPK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRAC O W 18.27 R W AND 288.200 WAC. <br /> Q—D <br /> ignatu o wner o actorl uthodze gent ale <br />