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P�RNIIT APPLICATIC�.�I <br /> �� CITY OF EVERETT PERMIT SERVICES <br /> 3200 GEDAF STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.N PERMIT H O <br /> 6/,� -v � G�J� �l/O 'v ��Z�f DD� DD/00 I R�iU — OZO <br /> LEGAL LGT N0. BLOCK TRACT <br /> DESC <br /> OWNE"r.� ADDRESS ZIP PHONE <br /> �(.onsl� �(r� �f2f /6 OI �jy� � /1 1��. S� �1h�Oc�/ 12� / �� 7�G� <br /> � � Dil��✓Y Y <br /> TENANTNAME CONTAC7NAMEi PHONE <br /> i ��il ri! Sy3 S �� �1v2� I d��l�.� �:.��u G-H �ZJ" - f37H- isz 8 <br /> CONTRACTOR ADDRE55 ZIP CONTR.0 ENSEN <br /> � GJooAS �akE" Co-.:Toir �r,La..� i.rZ�o Z7r�`S q �J�SLc g83� <br /> I PHONE — !-1`77^Z � <br /> :%2s - svG- r� �a5' ,v-v� s� �,v,.�b� <br /> � PROPOSED USE Of BUILDING Building [� Mechanical Addition MEAT SOURCE <br /> ! ��,/� PERMIT � Combination I { Plumbing WORK � Alteralion � Electric <br /> '. TYPE Demolilion [l Sign 7'YPE New Gas <br /> Sprinkler Repair/MainL O�her <br /> CONTRACT PRICE OF WORK /y v-�.� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION > / <br /> � �nSYiv `/ JC�•s�n` �.✓.e l� / �'��o� N i ��. � <br /> � � � � � � <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> _ BAIHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIFEPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DFINKING FOUNTAIN = GAS FIFEPLACE { <br /> _ FLOOR DRAIN GAS RANGE 3 <br /> BACKFLOW PHEVENTER GAS PIPING 5 <br /> _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I I <br /> I HEHEBY CEFITIFY THl�T I HAVE RE1D AND EXAMINE�THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS A�JD ORIDINACES GOVERNING TH�S TYPE OF WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GAANTING OF///���PERMIT GOE NOT PRESUME TO GIVE AUTHORI IY TO VIOLATE OR CANCEL THE PfiOVISION OF ANY OTHER i <br /> STATE OR LOCAL LAN�GULATING NSTRUCTION OR THE PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS RO RTY TO P FORM THE WOqK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC70FS VJ 48. � R AND 296200 WHC. J <br /> / � <br /> O � <br /> Signature of O n , tractor/Aulhorized Agent D e <br /> Z <br /> ', <br /> } <br />