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PL.�MIT APPLICATI�. J �g <br /> CITY OF EVERETT PERMIT SERVICES � 'UA <br /> 3200 CEDAR STREET, EVERETT, WA 98201 „�� <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AOD{iESS PARCEL TAX I.D.R PERMIT x <br /> o ao /G� D o008 l <br /> LEGA LOT N0. BLOCK TRPCT <br /> �ESC. <br /> OWNER AD�RESS ZIP PHONE <br /> ��' �.��h��'lL �4.�oO ��fe?.�teivr/'�,�``�.ui <br /> TENANT NAME CONTACT NAME � PHONE <br /> ��v/t ��� I .�+ � .�.hece /,��5- 71F�-9!/7 <br /> C T CTOR AD RESS 21P CONTfl.LICENSE M <br /> ,�Ju'Ea- ��. �,o,� ir�- 3� qSx-�5 P�IcoctJ3J i <br /> PHONE � � �� y� 7 � / !I / � �'�' �'lJ �JIJ' � I �5 <br /> / <br /> PROPOSED USE OF BUILDING Building I� Mechanical Addilion HEAT SOURCE <br /> PERMIT Combination K Plumbing WORK Alteration R Electric <br /> TYPE Demolition L] Sign TYPE �New P51 Gas <br /> Sprinkler � Repair/Maint. L� Other <br /> CONTFACT PRICE OF WORK _�;3.�c� �"7� j�J� CITV OF EVERE7`LOCAL SALES TAX CODE IS 3105 <br /> �yLZ <br /> WORK DESCRIPTION <br /> � ��� �� � �l� <br /> ������ .� � ' � ��., <br /> UMBING / MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE U�FIXTURE OR ITEM <br /> � WATER CLOSET A/C—A/HANDLING UNiTS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> I _ VATORY(WASH BASIN) _ HEAT PUMP <br /> SH ER UNIT HEATEH�• <br /> KITCH SINK 8 DISPOSAL OTHES DFYER <br /> DISHWAS R RA E HOOD <br /> LAUNDRY T WATE EATER <br /> _ CLOTHES WAS _ METAL FI PLACE/STOVE <br /> I _ URINAL _ FIREPLACE I ERT <br /> DRINKING FOUNTAIN GAS FIREP�C <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) EXHAUST FAN <br /> = OTHER \ = OTHER <br /> \ <br /> \ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF <br /> STATE OR LOCAL LAW RcGULATI�lG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THA'I AM AUTHORIZED BY 1.1E <br /> OWNER OF TH�S PROPERTY TO PERFO�THE WORK FOfl WHICH APPLICATION IS MADE AND I COMPLY WITH THE STA"fE <br /> CONT A TOR \W 1827 R AND 6. OO W C. � <br /> �n Z ' / i � •7 <br /> � ignal re of OwnedContractodAut orized Agent ate <br /> i '/z <br />