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P`�.RMIT APPLICATIC.�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE'f-1', WA 98201 <br /> 425-257-8810— FAX 425-257-SF757 <br /> SITE ADDRESS PARCEL TAX I.D.R P MIT u <br /> a9/i «r 6 ,Q�� (o c � z g , 9 zc .�3cil -CUO� <br /> LEGA LOTNO. 6LOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PHONE <br /> �vLiQ,-� ��� c�l-fr � Z y/l cc�I1v /9 ✓Q_- <br /> TENANTNAME CONI�ACTNAME PHONE <br /> �vcr���- fiHcq�rc I S'�tv� /�Lovy (, �zS- 77�- �"S3S' <br /> CONTRACTOR �7 ��� �/,�aN � p ADORESS �� �uK 5L 6 �/ 21P CONTR.LICENSEp <br /> PHONE '��^�^' woUI�JC,/F �J$o(�� �GfryNto77c �+7 <br /> t�zS 77L- " Ss83S' � <br /> PROPOSED USE OF BUILOING Building �Chanical Addition HEAT SOURCE <br /> PERMIT R Combination PI mbing WORK Alleration n Electric <br /> 7YPE D Demolition ign TYPE ew � Gas <br /> 7li eA-Fr� U Sprinkler Hepair/M1lnint. Olher <br /> CONTPACT PFICE OF WORK '�� � t�Z , O,� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK�ESCRIPTION �NS��LC �1� �C� �� X g�Z�� O��( t�CoF Le� d�5��(y <br /> I I PLUMBING MECHANICAL <br />' NO. NPE OF FIXTUPE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C–NHANDIING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAI. CLOTHES DFiYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL�IREPLACE/STOVE <br /> URINAL FIREPLr10E INS[RT <br /> DRINKING FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> � _ BACKFLOW PFEVENTER GAS PIPING <br /> SINK (SERVICEiBARlMOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I — — <br /> I HEFEBY GERITIFY'HAT I HAVE READ AND EXAM1IINED THIS APPUCATION ANO KNOW THE SAME TO BE TRUE AND COFRECT. AlL <br /> � PROVISIONS OP L1WS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHEiNER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT OOES NOT PRESU�1E TO GIVE AUTHOFIT'TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> i STATE OR LOCAL LAW REGCLATING CONSTFiUCTION OR THE PERFOfih1ANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED E��THE <br /> OWNER OF THIS PROPERN TO PERF h7 TI K FQR WHICH APPLICAT�ON IS 6fADE AND I COh1P�- WITH TH�ST,1TE <br /> CONTRACTORS LAW 1 RC � � � � <br /> , � /�-.�\ ��� <br /> Signat er/ContractodAulhorizad Agent Dale ` i N �� <br /> I V � <br />