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� �ERMIT APPLICA" :ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS 1�ARCEL TAX I.D.k PERMIT w <br /> s3o 9 ���u,a� ��-� � ko o r-oai <br /> LEGA LCTNO. BLOCK TRAC7 <br /> DESC. <br /> OWNER AODRESS Z1P PHONE <br /> L/tN c�: ���m �,v <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR AODRESS <br /> �O.B/ic-<5[Y�J QL^.c(p. ZIP CONTR,UCENSE N <br /> PHONE a9a3v /`��i� '¢yC-s �-C� ��223 IPG�,g,K,�y(27L <br /> ('alo�J4o�- 7v-�� <br /> PROPOSED USE OF BUILDING BUilding MeCheniCal Addilion <br /> PERMIT Combination R Piumbing WORK A�I rafion MEAT SOURCE <br /> �v�� �R TYPE D lilion Electric <br /> d Sign NpE New Gas <br /> prinkler Repair/Maint. Olher <br /> I CONTRACT PqICE OF WOpK ��� CITY OF EVEpETT LOCAL SALcS TAX COOE IS 3105 <br /> WORK DESCRIpTON <br /> �/C.�S Y3Zf /�i/lL ��tit�LG�-,.S /�t/ /�--�-'�v .C�[�r�G c-�Z <br /> � <br /> IPLUf,�BING <br /> � MECHANICAL <br /> , NO. TYPE OF FIXTURE O:a ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ q/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(VkASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYEfl <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLUW PREVENTER _ GAS PIPING <br /> _ SINK(SEflVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER <br /> — _ OTHER <br /> — � .ei.c..r� �`�`�i9-.JS <br /> I HEREBY CFflITIFY?IiAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORRECT. ALL <br /> PROVISIONS OF 1.,1W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCAL lAW fiEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP�_ TO PERFCRM THE WORK FOR WHICH APPLICATION IS MADE AND I COM1IPLY WITH THE STATE <br /> CON7RACTORS L W�� .2 RCW 96.200 WAC. <br /> �� l �IO�Q� <br /> Si ure ot OwneUContractovAulhonzed Agent Date ^ \ <br /> ,� <br /> z <br />