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P�r�MIT APPLICATI�.J <br /> CITY OF EVERc'TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AODRESS PARCEL TAX I.D.A ,pERMi x_ - a^ <br /> - �zy C 1u�6-� �� oos�so - o�2 -cr,�-oc� 1� v a <br /> LEGA LOT NO. BLOCK 'i RqCT <br /> DESC. �d, Z 2 1 1 ' <br /> 1�� `/- 011�f u N <br /> OW/N'ER AD qESS ZIp pHONE <br /> I�PrJ �au� C �2 y Ld/u���y /� e q51d3 �v2>>5'?� 35a �- <br /> TENANT NAME n � CONTACT I�AMJ� <br /> �� �1 PHONE <br /> /! /l <br /> � � � l��\�v,� <br /> CONTRACTOR ADDRESS LP CONTR.LICENSEM <br /> PHONE ��' /�1(` ' 1� �V U C <br /> r <br /> PROPOSED USE OF BUILDING Buiiding Mechanical Adtliiion HEAT SOURCE <br /> /'� PERh71T �Combination R plumbing WpqK � qlteration Electric <br /> �����.-(-J n-�, 7'YFE Demolition � Sign 7YpE New Gas <br /> !' Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CfTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ��,�1� ��oo�y F�. �j�rh f c� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FlXTURE OR 17EM <br /> _ WATER CLOSET _ q/C-A/HANDLING UNITS <br /> _ BATHTUB <br /> i _ LAVATORY(WASH BASIN) — FORCED AIR SYSTEMS <br /> I _ SHOWER _ HEAT PUMP <br /> _ KITCHEN SINK 8 DISPOSAL — UNIT HEATERS <br /> ' _ DISHWASHER _ CLOTHES DRYER <br /> � _ LAUNDRY TRAY _ RANGE HOOD <br /> _ CLOTHES WASHER — WATER HEATER <br /> _ URINAL _ METAL FIREPLACE/STOVE <br /> _ DRINKING FOUNTAIN — F�REPLACE INSERT <br /> _ FLOOR DRAIN _ GAS FIREPLACE <br /> _, BACKFLOW PfiEVENTER — �AS RANGE <br /> _ SINK(SERVICE/BAR/MOP/ETCJ — �A� P�PING <br /> ._ OTHER _ EXHAUSTFAN ��N� <br /> — � ^ 1 N � _ OTHER <br /> lJ <br /> ; I HEREBY CERITIFY'HAT I HAVE RF11D AND E�(AMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COFFECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COh7PUED WITH WHEfHER SPECIFIED HERE�,1 OR <br /> NOT. THE GRANTING CF A PERMIT DOES NOT PRESUME TO G�VE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOC.1L LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERIY TO PEFFORM THE WOqK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACT CW AND 296200 WAC. <br /> � O CJ Z <br /> � Signat ontractor/Authonzetl Agent D e <br /> i <br /> �/o�. <br />