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PE_ ZMIT APPLICATIO : <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.N I PERMiT x <br /> La�c�£►Z- — „ � -�oo �Qa� Cow7-ooy <br /> LEGA LOqTNO. BLOCK TRJ�ACT <br /> DESC. 1 I /'� W �S1 t�G� <br /> OWNER ADDRESS AP PFiONE <br /> yzj <br /> �(�.ItE. �AY�'�., �f q5/ G��C��'1z [,�vF 339 - s�z� <br /> TENANTNAME CONTACTNAME PHONE <br /> sp�- I�l„�.,Ic. �Cear-r-Eu��-io 43s ss�X <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> ¢���n��ssacr.c� 'a,u���s 3Z� 5, 1-1� Leo� A-� �O�J13Io16�] <br /> PHONE �L��q,�-�� <br /> u � WA- Q XLZ� <br /> PROPOSED USE OF BUILDING B�� ,�ng D Mechanical �j.Addition HEAT SOURCE <br /> � / PERMIT � Combinalion U Plumbing WORK n Alleration a Ek•ctric <br /> ��///�!� TYPE Demolition U Sign 7YPE R New Gas <br /> "� Sprinkler Ll Repair/Meinl. B Other <br /> CONTRACT PRICE OF WORK f C��O 00.U a CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTON , <br /> � � X Z $ Eir� `JINcJ�C 51� � /�1l`1�\ I � � <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEhA �� <br /> WATER CLOSET A/C—A/HANOLING UNITS <br /> BATHTUB _ FORCED P�R SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER t UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY • WATER HEATER <br /> CLOTHES WASHER METAL FIREPIACElSTOVE <br /> URINAL _ FIFEPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> , SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER_ <br /> � — — <br /> � <br /> I HEREBY CERITIFY'HAT I HAVE RE1D AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> IPROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHtTHI'R SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO G1VE AUTHORITY TO VIOLATE OR CANCEL THE F iOVISIOtJ OF ANY OTHER <br /> � STATE OR LOCAL U+W REGULATING CONSTRUC�TION 0 THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PE FORM �WOR OR WHICH APPLICA ION S MADE AND I COMPLY'NITH THE STATE <br /> � CONTRACTORS LA RCW f`t 296. AC. <br /> � '' � 3 0 v <br /> SignaWre Owner/ ontractoqAut r}2 Ag t te � <br /> � l <br />