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PE ;MlT APPLk�,ATlO� : <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS fARCEL TAl(I.D.q PER T u .� <br /> 3s'o� _ Cv l h� , Fvc�.EiT lAm��NE�� I �� ��/� <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. �• �p N uf�q <br /> OWNER ADORE55 ZIP PHONE <br /> �/�n�c' �'n.�et' �N�Es'�o� !� �+K 4`30, /Qn,��'fiw, l,�ti. �kL2?/3Go Y3S- �6?� <br /> TENANTNAME CONTACTNAME PHONE <br /> cJA . S;�iE A�coirun-s D�f��`E I �1�+0✓� ���^-� � 360 431' d'6Li� <br /> CONTRACTOR DDRESS ZIP CONTR.LIC[NSE M <br /> Ti�.aa.Su�Err�'x.n� (l�•a��sz�t"ES�cs. �J !3o}< <F3v_��'�+.�.u�ti, jR.o�vsS a,3 t7E <br /> PHONE 3� y3s'86 z c� � j `�ZL� <br /> PROPOSED USE OF BUILDING I �[ Uil Ing eChaniCal Addition HEAT SOURCE <br /> �F,�„�C� ��G� .-� Q AO "'� PERMIT r} Combinalion Plumbing WORK �Alteralion I � Electric <br /> (SI.Cv,tC. W TYPE g Demolilion Sign TYPE New Gus <br /> Spnnkler RepairiMairn. Other <br /> CONTRACT Pa'CE OF NOR 3U�DO O CITY OF EVER[TT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION , <br /> F,v�s� /dPPM1C. Zobo �f-'� o�G�.�i�vicNQ� S/��47G���Gi.n. Oc�,,���7 fw !(/1f1�D r') <br /> ��. c�F�z' .fFA�o -(vz S�,oro �D.,w;r�w . <br /> PLUME�ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OH ITEM <br /> WATER CLOSET A/C—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> ' DISHWASHEH I RANGE HOOD <br /> ' LAUNDRY TRAY __ WATER HEATER <br /> ' CLOTHES WASHER METAL FIREPLACE/STOVE <br /> ' URINAL FIFEPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREFLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) EXHAUST FAN <br /> _ OTHER � OTHER <br /> I HEREBY CERITIPY THAT I HAVE READ AND EXAtdINED THIS APPLICATICk AND KNON'THE SAME TO BE TRUE ANO COFRECT. ALL <br /> PPOVISIONS OF LqWS AfJ00RIDINACES GOVERNING THIS TVPE OF WOAK WILL BE COIdPLIED WITH WHETHER SPEGFIED HEREiN CR <br /> N07. ThE GRANTING C=A PERMIT DOES NOT PRESUME f0 GNE AUTHOFITY TO VIOL4TE CR CANCEL THE PROVISIOIJ OF ANY OTNER <br /> STATe OR LUCAL LAIN FEGULATING CONSTRUCTION OR THE PERFORMhNCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORAI THE WCRK FOR 6YHICH APPLICATION IS M1IA�E�1ND I COMPLY WIiH THE STATE <br /> CONTRACTORS LAW 1B.27 RC'N AND 296.200 WAC. <br /> � s�//e�-� <br /> Sig� ot wneriC tra/ctp/Awhon� Agent % Date <br /> ` ��Z <br />