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P�..r�MIT APPLICATIC .J <br /> CITY qF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, bVA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADORESS PAFiCEL TAX I.D. q PERMIT x <br /> �.,�Z I c:ll S-t M�2o9 -oa� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RESS ZIP PHONE <br /> u ZS <br /> '��2 cu� �, �����.;w Z�� z � Fv �+a� Sfi . ��re,1-i �+5 ��zci i �s8 c�iz� <br /> TENANT NAME I CONTACT NAME PHONE <br /> c%t.1�✓u <br /> -��-�"� 5 -1� �l ✓2° � `i�-f <br /> CONTRACTOR Q LL�'"`L.y" AD�RESS ZIP CONTR. LICENSE q <br /> PHON <br /> 12`� Z�' C,�I Z�- <br /> PROPOSED USE OF BUILDING Building Rp Mechanical Addition tiEAT SOURCE <br /> I PEfiMIT g Combinalion ��' Plumbing WOFK Alleration �Electnc <br /> TYPE D Demolition LJ Sign TYPE Ne�v Gas <br /> U Sprinkler Repair,?daint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> WORK DESCFiIPTION <br /> � ns-ta�e t_P ��� 5�-c��c w t{�h :t����„-���-o -f-�o i 2U c�ei.Q L t°c�ow C'c��-u.i r�a� <br /> � C a' '1 � l�a'Yl�>es <br /> � <br /> ' PLUMBING MECHANICAL <br /> ' NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET A/C—NHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEti1S <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> : SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISH�VASHER RANGE HOOD <br /> , LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/S'fOVE <br /> UR�NAL FIREPIACE INSERT <br /> DRINKING FOUNTAIN �. GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACI<FLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HERE9Y CERITIFY'HAT I HAVE READ ANO E)CAtdINED THIS APPUCATION AND KNOW THE SA61E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OP LAWS FND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PER�+11T DOES NOT PRESUh1E TO GIVE AUTHOFIIV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAI LAW REGUWTING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE � <br /> OWNEFi OF THIS PFOPERTY TO PERFORM THE WORK POR WHICH APPLiCATION IS WADE ANQ 1 COhiPLY WITH THE STATE <br /> CONTRACTORS L.AW 1827 RC'N AND 296200 WAC. <br /> �� - <br /> �.' �'��ivz C t�l�°.::_• G �c��a� <br /> Signawre ol OwneuContracror/Authonzed Agent � a-3 le <br />