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P�RMIT APPLICATI��I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SZ O — v e�r r c-✓ /� <br /> SITE ADDRESS PARCEL TAl(I.D.N PERMIT x <br /> �6zso s-r- ooz -o�a 3 Soao3 -uti� <br /> LEGA LOTNO. BLOCK TRAQT <br /> OESC <br /> OWNEFl ADDRESS ZIP PHONE <br /> �oS�..✓ l�ro ��e,�:.� 11/��la Iy�S� NI� /.3�i/c�� �,-9 �f' OO� <br /> TENANT NAME I CONTACT NAME PHONE <br /> Dis I Q c og-� � � S'fe�� �Co� l. �{ZS= 77L-$$3S <br /> CONTRA OR AD�RESS ZIP CONTR.UCENSE N <br /> �/�� �1/Lu.v Co f�0. /,gU�r S Z �. `i L�/•vivwoct�j 4./- `���/6 <br /> PHONE �Grr Go 7 7 < <"'` <br /> �zs= 776-$8'3s <br /> PROPOSED USE OF BUILDING I� BUiiding MeChaniCal Addilion HEAT SOURCE <br /> PERMIT K Combinalion�Plumbing WORK ��teretion R Electric <br /> 7YPE Demoiillon Si n TYPE ew u Gas <br /> {..( 9 <br /> L� Sprinkler RepaidMaint. LJ Other <br /> CONTRACT PRICE OF WORK � � 13 O �•� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION i. � `��` s Si�,� ��Yy,u.#'S <br /> ni.7l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET _ A1C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BAS�N) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE H000 <br /> LAUNDRY TRAY _ WATER HEATER <br />/ CLOTHES WASHER _ METAI FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE � <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIUN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �� <br /> PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER �iI <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> AWNER OF 1'HIS PRO RTY PERFORM T WOR R WHICH APPLICATION IS MADE AND I COMPLY WITH THE STP.TE . <br /> CONTRACTOFS 18.2 CW � i <br /> �/�/-o Z � <br /> Sig ure o OwnerlContractodAulhonzed Agent �e�e ��i i <br />