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P�c3�-�tz� <br /> P� �IVIIT APPLICATIt J �'�� � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STf�EET, EVERETT, WA 982G1 <br /> 425-257-8810 - FAX 425-257-8857 <br /> �`�5�o� <br /> SIT�ErADDR,� � `' PARCEL TAX I.D. # PERMIT x <br /> ���' � Oc�S��°100002�c� /Y17�7 27 <br /> �"�LV VV <br /> LEGA LOT NO. BLOCt: TRACT <br /> DESC. ' <br /> OWIvEfl ADDRESS ZIP PHONE '. <br /> E�tC���CT1 uX�tlj �i)�QnC�,�c . �200 6�t t�,� ��l! , ���t�-,u.�l �8�c�� <br /> TENANT NAME CONTACT NAME �-�'� 3 C�0 !p �O I OO L,� PHONE <br /> S"�i '�P�L-g �I y�z I�ti`�,ts'(1 c1C1��U�t.- 31Q0 �"1S 1 �b9.� <br /> CONTRACTOR ADDRESS ZIP CONTR. LICENSE A <br /> R��-� mect��e�-.��c . �� t� puo� c,��� �M ��y 1 �a <br /> nPH�O,,N/�E ^t�� /-(�` �,L�L-���C'���, V.a 1 'l UZ7� �1�171�.C��'1SlLl� <br /> !"')C 1 J• 1�� / 'F�J-�1� <br /> I �PROPOSED USE OF BUILDING n Building � Mechanical Addition HEAT SOURCE <br /> PERMIT {�-(( Combination Plumbing WORK Alteralion n�[ Elec!ric <br /> I � TYPE �j Demolition Sign TYPE Netiv � �j Gas <br /> Lr f�_,,� ( u Sprink!er I RepaidMaint. L� Other <br /> CONTRACT PRICE OF WORK � ! O� � ,Q� CITY OF EVERETT LOCAL SALES TAX COOE IS 31U5 <br /> ( L <br /> WORKDESCRI?TION l/ �� (/(( L' �' �LC ,�/t'1CJiC' �D�Oi/lG�4 <br /> � �?$�C. t b Ct//✓� ( � � � � � i <br /> ! � ��//7sEr,.( [ C.� �� p��str��(.�a.�ca<--- ��s���� q, cf�..s �� � �����c). <br /> � � <br /> PLUMBING MEChJANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i _ WATER CLOSET � A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> I — SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> GISHWASHER �� RANGE HOOD <br /> � LAUNDRY TRAY ,� , ����" WATER H[ATER <br />_ � CLOTHES WASHER I n\ �� _ METAL FIREPLACE/STOVE <br /> ' URINAL '� nQ FIREPLACE INSERT <br /> — `�, , <br /> _ DRINKING FOUNTAIN \' � � \ GAS FIREPLACE <br /> FLOOR DRAIN �' � GAS RANGE <br /> � BACKFLOW PREVENTER I �+��! GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) ;/�I ' EXHAUST FAN <br /> OTHER � OTHER <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO 8[TRUE AND CORRECT. A�L <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS TYPE OF WORK`,NIIL BE COtdPLIED WITH WHETHER SPECIFIED HEaEIN OR <br /> NOT. THE GRANTING OF A PERP.IIT�OES NOT PRESUME TO GIVE AUTHORIN TO VIOLITE OR CANCEL THE PP.OVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTIOh OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUT"HORIZED BY THE <br /> OWNER HIS P G,�RTY TO PERFORM THE WOFiK FOR WHICH APPLICdTION IS t.fAOE AND I COh1PLY WITH THE STA7E <br /> C VT CTORS LAW 18� RCW AND 296200 WAC. <br /> Sig a ure o- TracTou u onze Agent �O � t <br /> lv <br /> �� clob��-�= <br />