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P�RMIT APPLICATI(��V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRES PARCEL TAX I.D.M � P�RMIT R _O� <br /> � 09 �O.P�ST �/ELV Af. QOloo37�9�0700 (�/� <br /> LEGA LOTNO. BLOCK TRACT r <br /> DESC. IO�J af.� �-O ��� V�G� <br /> OWNER ADDRESS ZIP PNONE Ii1,s� <br /> � <br /> C,h�AQI-�S ���'Q�uS �iog F��sr ✓,��w a�. Ev�Es�w� 9�2� 3ss- e�� <br /> TENANTNAME CONTACTNAME PHONE <br /> ,1��/,v(,�B�L � SU!_ N�,,,, �/zS-'fg�-Q�' <br /> �,�, <br /> CONTRACTOR ADORESSO�a� ^�A,u r,f. ZIP CONTR.LICENSE M <br /> �UNDA�I�� ���� �'�Yic�S / ��'� a �p ��3 <br /> PHONE (/ZS'-7Li�'�,C/L'C�' ��6LG, WII. 7o�II �.UDA�SOG�✓� / <br /> 7 <br /> PROPOSED USE OF BUILDING Building �Mechanlcal Addition HEAT SOURCE <br /> �L� PERMIT B Combinallon Plumbing WORK�Alteration �Electric <br /> I�-�� TYPE Dernolilion Sign TYPE New Gas <br /> B Sprinkler AepairlMeint. Other <br /> CONTRACT PRICE OF WORK 59"'�S �� CITV OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORKOESCRIPTION './>����� �AS F�/�u��G� G�/'/� H�����/IND �AS Gd(t �T <br /> /v7r/r <br /> �/c co�L �,v�y �,C��uc�.�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> _ WATER CLOSET A!C-A/HANDLING UNITS <br /> _ BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHO�VER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DFYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY L WATER HEATER <br /> I _ CLOTHES WASHER = METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DHINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> i _ BACKFLOW PREVENTER 3 GAS PIPING <br /> � SINK (SERVICE/BAR/MOP/ETC.) EXHAUST AN �k5 <br /> i OTHER � OTHER S <br /> I — — <br /> �� I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICAI'ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> ��, PROVIS�ONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEC�FIED HEPEIN OR <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR CAL U1W REGULATING CONSTRUCTION Oq THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> i OWNER HI PROPERTY TO PERFORM THE WORK FOfl WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTR T W 10.27 RCW AND 296200 WAC. <br /> � car���r �-��= <br /> Signa o 0 eUContractor/A thorized Agent Date <br />