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SEP-IB-01 10:3d FR01hNORTHWEST-�SIIMR 206-?'4-0834 T-233 P.02/02 F-112 <br /> � PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAp STREET, EVERETT, WA 98201, 425-257-8810 I <br /> i <br /> SITE AODRESS * PARCEL TAX I.D.k i'eRMIT N <br /> 10 12 � �Qt'� Vl�v� �a\ �- O � 001 (�(� � <br /> LEGAL LOT NO. BLOCK TRAC7 <br /> OESC. <br /> OWNER � �;1� ADDRESS O 3Z� � P y,�s_ <br /> Scv0.b Kl c��► 'a��� l �ial ��-�ve�U ��'Y y �� b - Fs �� <br /> TENANTNAME CONTACTNAME �HONE <br /> / �� 1 /^ Zo 6 - <br /> �cv� �' �t�'7 ( � �cv�0�i C.�, M � 4� 1r 3"3-�'-6 6 ° `I <br /> GONTRACTOR � ADDRESS CONTR. LlCENSEN <br /> W C s c o a e o o `f�o w� '1�,.( (c� 1���F A s�1E5 9 9�C`'� ( <br /> PMONE a-d6 - J- FJ� - tI�VU JPO� y�19 _I I <br /> I PROPOSEQ USE OF EUILDING Building echenical nddlUon HEAT SOURCE <br /> PERMIT RComhination PIumG(ng WORK niterauon R ��''•= <br /> Typ� B DemolRion Sign TYPE � New ,{�f G°g <br /> S-�t� Spdnkler ! RepairiMeint. U oiher <br /> CONTRACT PRICE OF WORK� � 0 O O �� CITY OF EVERETT LOCAL 9AL@S TAX CODE IS 3105 <br /> WORK DESCRIPTION � <br /> � d �'' 1 o O � .�l."i Q, e.p 7� a 4 3 �t/�..�Ta �nP v�h' <br /> � � d <br /> PLUM81 G M CHANICAL <br /> NO. TIVE OF flXTURE OR fTEM NO. TYPE OF FlXTUAE OR tTEM <br /> _ WATERCLOSEf _ AIC—A/HANDLINGUNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> ,_ LAVATORY(WASH B<�SIN) _ HEA7 PUMP <br /> � SNOWER � UNIT HEATEPS <br /> _ KI7CHEN SINK 8 OISF'OSAL _ CLOTHE:.DRYER <br /> _ OISHWASHER RANGE HOOD <br /> LAUN�RY TRAY �_ WATER HE�TER <br /> _ CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVEM'ER GAS PIPINCZ <br /> � SINK(SERVICE/BAWpAOP/�TC.) � EXFiAUST FAN <br /> OTHEFI^ _ T OTHER <br /> I HEREBY CERITIFY THAT I HA\�E READ AND pCAMINEO 7NIS APF,.ICATION AND KNOW THE SAME TO 9E 7RUE AND CONREC7. ALL <br /> pROViSIONS OF IAWS AND OFIIDlNACES GOVERNING7HIS 7YPE OF WORK WILL.BE COMPLIED WITH WHETHER SPECIFIED HERE{N OFi <br /> NOT. THE GRANTING OF A PEI9MIT�OES NOT PRESUME TO GIVE AUTHORITY 70 VIOU.TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL\TING CONS7RUCTiON OR THE PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHOhiIZED BY TNE <br /> OWNER OF THIS PROPEqTY Ti)PERFORM THE WORK FOR WHICH APPLICAl70N IS MADE FND I COMPLY WI7H 7HE S7A7E <br /> CONTRACTORS LAW 1C27 RC1N AND 29fi.200 WAC. <br /> � ��� ( �r�'1 <br /> Sigga re of Owner/Contracto geat----^"'— D te <br /> / <br />