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�''EIRMIT APPLICA"�'ON <br /> �ITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq g8201 <br /> 425-257-8810— FAX 425-257-8f357 <br /> SITE ADDRESS PARCEL TAX I.D, N <br /> �� d . ` �4� 1 PERMIT# <br /> �� x�3 c -oo� <br /> LEGA LOT NO. BLOCK TRACT <br /> �ESC. <br /> OWNER <br /> A�DRESS ZIP PHONE <br /> TENANT�'AME ���� �/�� ` �U���C/�iQ:�n �,.�;� <br /> CONTACTNAME <br /> �^ PHONE� <br /> —�;�7t1"f; _ �A�vl S _ L�t/ /� /M <br /> CONTRACTOq ��/� ��� '/ �����(y7 L,Ln ?�-. i <br /> �4'�J� �1���7/N� ADDRESS /��G �/l��.W ZIP CO,j'�TR.UCENSe�-- <br /> '� /7G/'�iO�-#-G <br /> PHONE `/� J � q�k r <br /> y � � <br /> - �z_ �v� �y�,,,. ����, .. s� d �b <br /> PROPOSED USE OF BUIL�ING � Buildin <br /> PERMIT 9 Mechanical Addition HEAT SOURCE <br /> Comhination Plumbing WORK Alierauon <br /> � TYPE Demolilion Sign TYpE New R Electric <br /> I Sprinkler �.J Gac <br /> i CONTRACT PqICE OF WORK Ropair/Maint LJ fJther <br /> C17Y OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> K'ORK DESCRIPTION <br /> i <br /> i <br /> i <br /> PLUMBING <br /> N0. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> NO. TYpE OF FIXTUqE OR ITEM <br /> _ WATER CLOSEf <br /> BATHTUB _. A!C—A/HANDL�NG UNITS <br /> � 3 LAVATORY(WASH BASIN) _ FORCED AIR SYSTEMS <br /> ' _ SHOWER _ HEAT PUMP <br /> _ KITCHEN SINK 8 DISPOSAL _ UNIT HEATERS <br /> � DISHWASHER _ CLOTHES DRYER <br /> � LAUNDRY TRAY __ RANGE HOOD <br /> I � CLOTHES WASHER --_ WATER HEATER <br /> � _ URINAL � METAL FIREPLAGE/STOVE <br /> _ DRINKING FOUNTAIN __ FIREPLACE INSERT <br /> I _ FLOOR DRAIN _ GAS F�REPLqCE <br /> I _ BACKFLOW PREVENTER _ GAS RANGE <br /> _ SINK(SERVICE/BAR/MOP/E7C.) _ GAS PIPING <br /> _ OTHER_�_ _ EXHAUST FAN <br /> _ _ OTHER�_ <br /> � HEflEBY CERITIFY 7HAT 1 HAVE READ AND EXAMItJED THIS APPLICATION AND KI OW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF L1W5 AND Oq�DINACES GOVERNING THIS TYPE OF WORK WILL BE COh1PLIED WITH WHEfHER SPECII-IED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUA1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISICN OF ANY OTHER <br /> ' STATE OR LOCAL LAW REGULATING CONSTRl1CTION OR THE PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CON'fRA iOFS LAW 78.27 RCW AND 296200 WAC. <br /> _�( �W�— ���� L� ��. � 4 7 V� <br /> Sign21 re ol Owneni oi Irac odAuthonzed Agent Date <br />