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�cRMIT APPLICAT�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAH STFEET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> ��7 G/Z <br /> SITE ADDRESS PARCEL TN(I.D.N PERMIT B <br /> �D$ �e2 �er� �A �" D2v 33 <br /> LEGA LOT NO. Bl0 K TRACT <br /> DESC. <br /> OWNER / ADDRESS ZIP PHONE � 2 S—�fY �Y7}I <br /> cT �^ �l7�rs�.✓ �S1 �v Z 7s`f�, �JEs6' �19z72 <br /> TENANT NAME CONTACT NAME // PHONE <br /> �2 t� �� Sol 13 � �,� �9- Clf�tr� ..� �2 3^,3�C(�' $73 <br /> CONTRACTO ADORESS LP CONTR.LICENSEM : <br /> q a��� ��e 2��, �.g��� 2� 9q�a � <br /> PHONE �kMb� Gl � .S'j� ZVs�CS�Y ; <br /> PROPOSEO USE OF BUILDING Q BUilding fl MecheniCel Addilion HEAT SOURCE <br /> PERMIT " COmbineti0n �q P�umbing WORK �Iteralion � Electric <br /> TYPE D Demolition L/ Sign TYPE New �eg <br /> U Sprinkfer Repeir/Maint. Other <br /> CONTRACT PRICE OF WORK � '7S"Q .�X CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> < <br /> WORK DESCRIPTION / <br /> �/1 f 'T H C / J�/q � � ��t' ��(�rfS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF Fl%TURE OR REM <br /> WATER CLOSET _ A/C-A/HANDIING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAI _ CLOTHES DRYER <br /> i OISHWASHER _ RANGE HOOD <br /> i _ LAUNDRY TRAY _ WATER HEATER <br /> i _ CLOTHES WASHER _ METAI FIREPLACE/STOVE � <br /> ; _ URINAL _ FIREPLACE INSERT <br /> � DRINKING FOUNTAIN _ GAS FIREPLACE <br /> —� FLOOR DRAIN _ GAS RANGE <br /> � BACKFLOW PREVENTER _ GAS PIPING <br /> � � SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST FAN <br /> — T� : = OTHER <br /> HF R <br /> '�-'L- t�o- c <br /> � <br /> i — <br /> — <br /> I — • <br /> I <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TFUE AND CORPECT. ALL <br /> � PROVISIONS OF fAWS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> �. NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PPOVISION OF ANY OTHER <br /> '. STATE OR LOCAL LAW REGULATI CONSTRUCTION OR THE PERFORMAN E OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> '� OWNER OF THIS PROPERTY TO RFORM THE FOR WHICH APPLI ION i MADE AND I COMPLY WITH THE STATE <br /> I CONTRACTOAS LAW 1827 N 296 AC. <br /> , Zr a� <br /> , <br /> Signature of Owner/Co r d uthorized Agent � e <br />