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�4/25/20�7 16:01 2062911500 SIMPLEXGRINNELL PAGE 02/02 <br /> 1 <br /> ��}�► PERMIT APPLICATION <br /> �M�__ CITY O�' EVERETT PERMIT SERVICES <br /> ��E7T 3p00 CEDAR STREET, EVERETT, WA 98201 <br /> i �� r 425-257-8810— rAX 425-257-8857 Y _ �� ` �� <br /> i <br /> SITEADDRESS �/�� w� PARCELTAXI.D.B PERMITF <br /> 11 n5 l3�"` tr�- `�$201 —�" — `� � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> O\VNER AODFE55 21P pHONE <br /> P�nt „r- �v�.t PD� e.tP W� �18`� �I-Z5 7�•3( . <br /> TGNANT NAME CON7ACT NAME PHONE ZQ�/j <br /> �ar4 C�cvr(l,n W �lcl� C� �6ar•lr w/nsrl`I lla� o'f�ea-r��,�'��i��^-Ke.9_Q ?�I� r 1� <br /> CUNTRACTOA S�h�r ��e`}y�L �DDFE55��,�,�2 (�m{�.(,� �. UP"(�� CONTR.LICENSEN <br /> � ,,�,y' SE.ANuE�-na9 <br /> I Pi�l.v'�-tt WA 1J�" <br /> PIi�NE � Z�$• ��iZ <br /> PqOPOSEtl USE OF BIJIL�ING I I� Buitding D Mechanical Addi�ion HEAT SOURCE <br /> PERh11T f�� Combina�ion Ll Plumbing WORK R Atlerellon D Electric <br /> Inn n ��i 1� u� TYPE K Damolilion U Slgn iYPE D New U Gas <br /> ���wr LI Sprink�er �j�,•,.� Alpr,.,� �-� RenAir/Meirn. U O�her <br /> CONTRACT PRICE OF WORK �$3� , Q Q CITY OF EVERETT IOCAL SAIES 7AR CO�E IS 3105 <br /> IWORKdESCRIPTION ��DVI��L+ QY`-Q.�.-�� �'OLO F/•FC.�A Tu� u �WV SIuY�-� bLUI �IT({'(iLQ. <br /> � Pvnf c�U.✓dr e.r g oc.� v�cv�h Fuc�' L�b�.� . Tkz b�u Id tv�q i S ta hG�rC, Cz.�e.Q 5wtol�e.� <br /> � -" . cl.e,rc.e,c�f;�yv� as �.ue.t1 as �1oh'h•caho,n dev�ce Sas ou..Fuw`EcC cn co�h-a,c.r ctvu,a��s- <br /> �� `f�e �y n,Pixv �� LCo awvv�wu-i caur �}a b� �IG��� c� 5k11u1Y1 Ovt d.l2�W� a. <br /> A�l C��v�'ctS.w� GNLI C0�1 fD bt �n5in.l�ul h E� �CJ•S�mP1e1[(a,�vtv�L r • <br /> PLUMBING MECHANICAL ��n Fcrvv� <br /> NO. T�PE OF FIRTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM ��� S� �''�� <br /> �L-k� . <br /> W:.i ER CLOSET AlC–A/HANDUNG UNITS <br /> BATHTUB FORCED AIF SYSTEMS <br /> _ LAVATORY (W�SH EASIN) _ HEAT PUMP <br /> _. SHOWER _ UNITHEATF_RS <br /> KITCHEN SINK 3 DISPOSAL CIOTHES ORYL"R <br /> DISHWASHER � FANGE HOOD <br /> _ IAUNDRY TRAY � WATER HEATER <br /> � _ CLOTHES WASHER METAL FIREPLACE/5'iOVE <br /> I _� URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACI<FLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> I � OTIIER � OTHEFi <br /> I — — <br /> I — — <br /> ��II HEf7E8Y CEfiITIFY THAT I HAVE READ ANO EXAMINBD THIS APPLICATION AND NNOW THE SAIdE 70 BE TFUE AND CORRECT, ALL <br /> P�OV�SIONS OF LAWS AND OAIDINACES GOVEFNINQ THIS 7YPE OF bVORK VJILL 8E COMPLIE�WITH WHETHER SPECIFIED HEREIN OR <br /> NO?. THE GRANTING OF A PERMIT DOES NO7 PRESUAIE 70 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STF7E OP LOCAL LAW REGULATINO CONSTRUCTION OR TH6 PERFORM1IAPICE OF CONSTRUCTION. THAT I AA1 AUTNORIZED BY THE <br /> ; ' �R OF THIS PFiOPERTY TO PBRFOFlM THE WORK FOR INHICH APPUCATION IS tdADE ANp I COtdPLY WITM THE STATE <br /> I �` fAC70R5 LAW 1@27 RCW AND 296.200 V�AC. <br /> �J ,/ � <br /> j �` ti�i.� ,n"�. �ir �'rri.0�.t, � nn �Z5 •�� <br /> � Signature'ot owner/ ontractor/n���d Agent Date <br /> i <br /> �-- — <br />