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�RMIT APPLICATI�N � <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> lf � 3 -� <br /> SITE ADD��S � � , 1 P)ARCEL TAX U q ���' PER a <br /> o �2o�'-a� <br /> ,�; <br /> LEGA LOT NO. BLOCK TRACT ' ) <br /> DESC. -�`��' '��Z � I �-�ilJT.G7 �/I(�iV <br /> OWNER AD�RESS ZIP PHONE <br /> �L�� �/ l f z //V{� T/�_��L �t,yl�2r��L Ll1iP ��/ �/�1�L/ � i <br /> TENANT NAh7E CONTACT NAME PHONE <br /> ��/���.�T ��//«f�.�� ��5 '���[p � � <br /> CONTRACTOR ADDRESS /� 2i CONTR. LICF.NSE k <br /> ,��.L�/.C%Cf�/1� CG7t>"7l1<fC"?7GtJ/�(.�, �7Z'f LlXin'f.!'GGts�� .p�%t-r�a�20�-�-g <br /> PHONE ���� <br /> ��'P �fZS -39'/0 li�'/� �1-�t�7rc� � s - Z-s�'/G'7l7 --� � �, <br /> PROPOSED USE OF BUILDING n Building f"1 Mechanical Adtlition !H�QT,SoURCE <br /> PERMIT �combinaiion F� Plumbing WOFK � Alteration / ,��flectric <br /> S�� TYPE D�Demolilian LJ Sign TYPE New I n Gas <br /> U Sprinkler Aepair���taint. D Oiher�- <br /> � <br /> CONTRACT PRICE OF WORK // �/ L%//� — CITY OF EVERETT LOCAL SALES TAX CO I�OS <br /> 0 O [/ <br /> WORK OESCRIPTiGN �� ,� <br /> , �j' �iG� c�7L� .tJ-�uJ ��71a= �-�'/( �-t%l�����2�'�=D�r�.e«� <br /> PLUMBING MECHANICAL <br /> I <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> � BATHTUB Z FOACED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK& DISPOSAI � CLOTFIES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> Z CLOTHES WASHER _ METAL FIREPtACE/STOVE <br /> URINAL FfREPLACE INSERT �G <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> , _ FLOOR DRAIN GAS RANGE p� <br /> BACKFLOW PREVENTER � GAS PIPING • S� <br /> SINK (SERVIC6'BARlMOPiETC.) EXHAUST FAN � � <br /> � = OTHER = OTHER � j <br /> — — � �I <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXA611NED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OP L1VJ5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESU�dE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PfiOVI510N OF ANY OTHEii <br /> STATE OR LOCAL LAW FEGULATING CONSTRUCTION QR THE PERFORMANCE OF CONSTRUCTION. THAT I AM1t AUTHORIZED BY THE <br /> C`NNER OF THIS PROPEFTY TO PEPFOR61 THE'NORK FOR WHICH APPLICATION IS�dAOE AND I COM1IPLY WITH THE STATE <br /> CONTPACTORS LAW 10.27 RC�V AND 296.20Q WAC. � <br /> C / / � r � <br /> � Z. L,�CC`l� i ��� �1� <br /> xA re ol Owneu ontractodAuthonz d Agent Date <br /> ��Z <br />