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�ERMlT APPLICAT�N <br /> CIT OF EVERETT PERMIT S VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS pARCEL TAX I.D.# PER AIT q <br /> � G � - 1� -('� F/cJ wl GC- oa53� o000 32oZ. �� ��-�- �v0 <br /> LEGA LOT NO. 6LOCK TRACT <br /> DESC. <br /> OWNER AD�RESS ZIP PHONE <br /> p u�p �,� ' <br /> �r L.,p��.s l�orr�s�l' �o5/ S �u6iS�eKv w[, C-"r.u�Tf 4-z5�3s3-33s5 <br /> TENANT NAME CONTACT NAME PHONE <br /> �w�`tN�. L�NE�s S�zv�l I t"�w�'� n�L I,.ANE� Sc�Z�{F-�t <br /> CONTqACTOR �*-`r i O-T �j 2� �����QDRESS Z'O"] 7p7/2 ��/Lc � ZIP CONTR.LICCENSE q <br /> PHONE Z53 - �5�-342) Ti�O/YtaQ � W� /��Zq' �FT�'ll '�0�� <br /> PqOPOSED USE OF BUILOING Building Mechanicdl Addilion HEAT SOURCE <br /> PERMIT R Combination R Plumbing WOqK � Allera�ion D Electric <br /> TYPE �� Demolition � Sign TYPE New � Gas <br /> ,�o�Sprinkler FepaidMaint U O�her <br /> CONTRACT PFICE OF WORK �/ �/g 3� ,OZ7 CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> �.r <br /> WORK DESCRIPTION <br /> .pcs�e��J An� io �NsTf+ ll �i I� G�PPS <br /> STf�rT� Nc.� Prt s� pp�� �rpN�� i � � i�-b <br /> � "13U� I I��n,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH �ASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ IAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ M'-�`iAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAFUMOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION AND K�'OW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETIIER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMtE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PfiOV�SION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OwNER OF THIS PROPERTY TO PERF9FlM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � TRACTORS LAW 1827 RCW AN,D�6.200 WAC. <br /> //) / <br /> ����///�/ ��z 7�0� <br /> Signa W re•af Owner/ConiractoNAulhonzed Agent Dale �� <br />