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P�RMIT APPLICATILN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98207 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N � PEaM1T r <br /> / g/ ��d AVe• oo�3,qa3Co9dZSoo G � � <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. 2s 2� 36 �Var�t1 P�J L f�la, i- <br /> OWNER ADDRESS ZIP PHONE <br /> ma.l,Mo�( A . ?�.(��- I S �N ��br A�e GVercN- 9�'� i (v�') ry 3 �v � <br /> TENANTNAME CONTACTNAME PHONE <br /> Yv�4.�,vrov.�( Z4.�tei'' I hn0.�»,ow�( �4 {te✓ �42t) 1�5 -3/41 <br /> CONTRACTOR ADDqESS <br /> Q W �CY � / �.. bP CONTq,LICENSE M <br /> SBrn�t M �y�-II�-� <br /> PMONE <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT � Combination R Piumbing WORK B Aiteration R Electric <br /> ��Y� � TYPE Demolilion � Sign TYPE D New �J Gas <br /> � Sprinkler U qepair/Mainl. U Other <br /> CONTRACT PRICE OF WORK � "_ //A/ 7 � <br /> � �JJ CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> Y G <br /> WORK DESCRIPTION � <br /> i� <br /> j� e�c���� �_� r�-� � <br /> PlUM81NG MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF flXTURE OR ITEM <br /> _ WATER CLOSET _ AfC–A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> __ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWEFi _ UN�T HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CL07HES WASHER _ METAL FIREPLACElSTOV[ <br /> _ URINAL _ FIREPLACE INSERT <br /> � _ DRINKINC,FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> I _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> t — <br /> 1 HEREBY CERITIFY 7HAT 1 HAVE READ AND EYAMINED THIS APPLICATION ANO KNOW TFiE SAME TO 8E TRUE AND CORRECT. ALI. <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GFANTING OF A PERMIT DOES NOT PPESUME TO GIVE AUTHOFIiY TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTNER <br /> STATE OR LOCAL LAW REGUTATIN(i CON57RUCTION Ofi THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE STA7E <br /> : CONTRACTORS LA 18.27 RCW AND 296200 WAC. <br /> � •L S �(i b )i <br /> Signalure ol Owne c1oUAulhorized Agent Date <br /> � i �/et <br />