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P�MIT APPLICATI(�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, �/��A 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.q PERMI7 x <br /> /G��St�� �1, ��ik�c�� `�� .SOu�li SUZ�-Cb <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P oHONE <br /> EV[!/yC <br /> P•"�c�,^mu�cc N%SSa� �USOd /�� 99 �e�f� +✓�+ <br /> TENANTNAME CONTACTNAME <br /> PHONE <br /> �!'�o:i,-+a,�Ce N�'s5�., �Grl Gc,.r�� �3Go) GS�- ,3 $2Y <br /> CONTRACTOR AOORESS ZIP CONTR.LICENSE N <br /> /7��//0 /Vrvn %`�' 72/ /G/f �Jve l�'.w� y8."17/ �1FvC�Nloy'/oo <br /> PHONE� 3G0 � C�S,Z' J ��. `! ��)�.�y5 v,'l/e w c.. CXp, y/�l/�vo y <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> i�tJ�c9�'✓+v �� Ve PERMIT Combina�ion Plumbing WORK Alteralion R Electric <br /> .U�G�e�S� .�J TYPE Spr nkleion �. Sign TMPE � Repair/Maint. LJ Other <br /> CONTRACT PRICE OF WORK �" C�/ �OO pc� CITY Of EVERETT LOCAL SALES TAR CODE IS 3105 <br /> / <br /> WORKOESCRIPTION `�j,��� ��3 f���G �t���^ / .�J ���� 3��ry5 <br /> 0 :Z �y/v� S ,�hS <br /> � <br /> (� �3 U.'.�ecf;�„u / 5.�n S <br /> I PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> ; _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) HEAT PUMP <br /> � _ SHOWER UNIT HEATERS <br /> � _ KITCHEN SINK & DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHEA _ RANGE HOOD <br /> � _ LAUNDFY TRAY WATER HEATER <br /> ' _ CLOTHES WASHER METAL FIREPIACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN GAS FIREPLACE <br /> � _ F100R 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 APPLICATION AN�KNOW THi?SAME TO BE TRUE AND COFFECT. ALL <br /> PRGVISIONS OF WWS AND OFIDINACES GOVEFNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GAANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWP:ER OF THIS PROPEHTY T �ERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC R¢LAW 1�.z"7 W/qND� 6.200 WAC. <br /> �� ��Ul �'� �j�,f�/o7� <br /> Signatur Owner/Co�tractodAuthorized Flgent Dat� �/a <br />