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PE_ ZMIT APPLICATIO`. . <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4•25-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.O.M PERMi7 x <br /> � 33 � c�oc.� � o�-oo� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER pODRESS 21P PMpNE <br /> �j7[c�✓ /-�-�+,✓j TT �10� � ��PPI" /�I�S. !`��l•,y �/z i . z s9. 3sS� <br /> TENANTNAME CONTACTNAME PHONE <br /> n�ce�/F��✓c�2 t�A�i c�<s F�t�n�IC („o.�z��r Yzs. y3� 8i� o <br /> CONTHACTOR A�OpESS ZIP CONTR.LICENSE N <br /> /��3��7-S�Gn/ St�2VtC�1' /�Z�1 �c7)�t( �vc-�.'7f y� MfZ3 i /�3Tsls #i io p� <br /> 425. 3'30 ,8'/(.o MILC �2c-�lG � inlrt- 1b`� 12 <br /> PROPOSED USE OF BUILDING I Building �Mechanical Addilion HEAT SOURCE <br /> PERMIT R Combinalion Plumbing WORK � nRera�ion � Eiectric <br /> ������� TYPE D Demolilion Sign TYPE New Gns <br /> U Sprinkle� Rapair/Maint. Other <br /> CONTRACT PRICE OF WORK �rI ��� CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> WORK OESCRIPTION <br /> I N S"r�ti.i.- No n1 - �����M r,�M�'0 �cT1z�Z Url �ur �Oi�(� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF PIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASINI HEAT PUMP <br /> SHOWEt� _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYEF <br /> _ DISHWP.SHER _ RANGE HOOD <br /> I = LAUNDfiY TRAY = WATER HEATER <br /> CLOTHES WASHEfl METAL FIREPLACE/STUVE <br /> i URINAL _ FIREPLACE INSERT <br /> i _ DFINKING FOUNTAIN _ GAS FIREPLACE <br /> � _ FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> � _ SINK (SERVICE/BARlMOP/ETC.) _ EXHAUST FAN <br /> i _ OTHER _ OTHER <br /> I . <br /> I HEREBY CERITIFY'HAT I HAVE REAO AND E;(AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. ALL <br /> PROVISIONS OF LA'N�ND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIF!ED HEREIN OR <br /> NOT. THE GRANT}71G 9 A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROV�SION OF ANY OTHER <br /> STATE OR LOC�C LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORi2ED BY THE <br /> OWNER Of THI PROPER iV TO PERfORM THE WO�K.FOR WHICH APPLICATION IS MADE AND I COMPLY W�TH THE STATC- <br /> CONTRACTORS LAW 18. 7 AC�W AND 29620�AL� <br /> �' ,�,�.- � 6�� ' � 5/13��a 5� <br /> SignaWre o�OwneNContractor/A� honzed Agent � Dat �� <br />