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�ERMIT APPLICA��N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS pAHCEL TAX I.D.N <br /> P�•RMIT w <br /> �909 �_r��� oosas�o��c'a� .�. v. � ;ZQ1-t3'('JZ <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. 3 GX��•.20D/ a.���S�Oae - s' � � �. �t <br /> OWNER �"_' /��C '3�o i7_���� � � WIt'! <br /> / ADDPESS 21P PHONE <br /> ��.v�z ¢�.e.�r� �c�/�' s� �a� u�.v�.c. S�or9 (7��Fr�9 ��li s <br /> 7ENANTNAME I CONTAC7NAME — <br /> PHON^ <br /> CONTRACTOR ADDRESS ZIP CONTR.UCENSE M <br /> �i «.�' �PasF'�%�z.�.c,��/%✓e -� a� �z -� <br /> rHor+�. 6�1(� �f/� �4�i3 ^l.3�u.-,e e�9btr7�. <br /> C�. �[ �r v.a�c., �rfr �/9 <br /> I PROPOSED USE OF BUILOING Building MeChaniCai Addition I HEAT SOURCE <br /> S�� PERMIT Combinalion Plumbing WOqK � Alleralion �n./ Electric <br /> ITYPE Demolition �Sign 1YpE Ne�.v �Q Gas <br /> Sprinkler Rapair/Maini. I U Other <br /> CONTRACT PRICE CF WORK �3, �p CITY OF EVERETT LOCAL SALES 7AX COUE IS 3105 <br /> WORK DESCRIPTfI N <br /> /�/�? cJC3�r�l'zA�u-,E7�, S„�sc��.�'�.�.,.�cr�Es.�2vcE' <br /> I G 2 /0 <br /> PLUMBING MECHANICAL - <br /> i P70. TYpE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET <br /> I BATHTUB fVC-A/HANDL'NGUNITS <br /> � � LAVATURY(WASH BASIN) � FORCED AIR SYSTEMS <br /> SHOWER _ HEATPUMP <br /> I � IQ i CHEN SINK$ DISPOSAL UNIT HEATERS <br /> � DISHWASHER �- CLOTHES DRYER <br /> I LAUNDRY TRAY �- RANGE HOOD <br /> / CLOTHES WASHER �_ WATER HEATER <br /> _ URINAL _ METAL FIREPLACE/STOVE <br /> _ DRINK�NG FOUNTAIN FIREPLACE INSERT <br /> _ FLOOR DRAIN � GAS FIREPI..ACE <br /> _ BACKFLOW PREVENTER _L,_ GAS RANGE <br /> Y• GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) 3 EXHAUST FAN <br /> _ OTHER <br /> _ OTHER <br /> I HEREBY CEflITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF lAWS A�'0 pqIDINACES GOV[RNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIF�ED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE PUTHORITY TO VIOL4TE OR CANCEI THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCAL LAW REGULP.TIN(:CONSTRUCTION OR THE PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br /> nWNER OF THIS PROP RTYppp TO PERFORM T 'NORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON7RACTORS �Z�W AAND 296. �AC. <br /> �+• �O -Z F-UZ <br /> Signalure o OwnerlC��tractodAulhonzed Agent Date <br /> r�z <br />