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P`�.RMIT APPLICATII. N <br /> CITY IJF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREeT, EVERETT, WA 98201 <br /> 425457-8810- FAX 425-257-8857 /j/d,� �O�,rr,'� � <br /> /.�p0/D -O <br /> SITE ADDP4SS PARCEL TAX I.D.p PERMiT a <br /> 3l�2.� Co �� ✓G 0.2C� -� <br /> LEGA LO7N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 2IP PHONE <br /> q�a�� - x:�� �s-y- y� s9 <br /> 5l<ot�-al pr,.►,.. �t�,Orr/f�� �fJ D,��. 5A� �..�,�f� <br /> TENANT NAME —� I CONTACT NAME PHONE <br /> CONTRACTOR (ti��/�t /I�t M Sr n� '��� ADORESS /272 Y O/ S AJ h.� Z�p CONTR.LICENSE M <br /> Mo��s.. .c4. 9�:�o w•cf6Pio9� c <br /> PHONE �60' S6 .�S � 96�S� <br /> PROPOSED USE OF BUILDING I I"1 Building � Mechanical Addiilon HEAT SOURCE <br /> ///��� PERMIT �_� Combination Plumbing WORK ��tera�lon I � Eleanc <br /> � n f$ TYPE �_l Demolilion Sign IYPE ew Gas <br /> lr U Spfinklef fiepai�/Maint. Other <br /> CONTRACT PRICE OF WORK �� �� CITY OF EVERETT LOCAL SALES TA7(COOE IS 3105 <br /> WORK DESCRIPTION �/K � S� ^ <br /> ( , <br /> IPWhiBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlJ(TURE OR ITEM <br /> � WATER CLOSET __ A/C-A/HA�dDLING UNITS I <br /> � dATHTUB _ FORCED AIR SYSTEMS <br /> I LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> �— KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> I � DISHWASHER RANGE HOOD / <br /> LALINDRY TRAY '� WATER HEATER � <br /> � � CIOTHES WASHER _ METALFIREPLACEJSTOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAW _ GAS FIREPLACE I ��� <br /> , � FLOOR DRAIN GAS RANGE ( <br /> ' �[ BACKFLOW PREVENTER � GAS PIPING <br /> � SINK(SERVICE,[BAR/MOP/ETC.) EXHAUST FAN <br /> .� OTHER�se F c�ti a n _ OTHER � <br /> �,�z A l.�l., � ra �w i- / <br /> 1 �a..A s� / �A (C �cc/AJf — <br /> l 7�e..�• r._1. <br /> 1 HEFEBV CEFITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE CUMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A AERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOI.ATE OR CANCEL THE PROVISION OF ANY OTHEF <br /> STATE OR LOCAL LAW AEGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br /> CONTFACTORS L.1W 78.27 RCW AND 296.200 WAC. <br /> _ i a- A w�i f'� y-1.�--� z <br /> SignaWre ol OwnedConlractoVAuthonzed Agent Date <br />