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P�RMIT APPLICATI�.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 PA CEL TAX I.D.N PEAMIT x <br /> � o � t� o�� -aoo -c� �5 -o� �i -o �� <br /> DESC. LO�NO._ BLOCK TRACT� . �� ��� � <br /> ��5 _;�e 6 <br /> OWNER ADDRESS ��y�a�,Z�I�P PHONE 5�� .yG98 <br /> rw.�ii/ /L(/ . <br /> ���� (�i��E y /a�9 �wN �U�t��qtszo � <br /> TENANTNAME �� CONTACTNAME pD�TG�._�.._.PHONE�� <br /> �{�GyC <br /> �o�LG r�.4N�vA-/'f A�-lfit�TS 3�8'Srit� <br /> CONTHACTOR O(�j((�fZ. A7DRESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OF BUILOING pERMIT �Su�inkleation I ) Plumbingal WURK B Repav/Maint. HEAT SEU�RCc <br /> TYPE H Demolilion � Sign TYPE New � Ulher <br /> ;�Q33Z- u <br /> CONTRA K /��QV G 7 ODO CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> n (` <br /> WORK DESCHIPTION ��D ���i �j(.��(�r CK�� ¢ �j��C 7"O f�l(� �(�C— <br /> /Cl�CJ Z�fL061L ��d77l7l�iG�/ !/ ��Cl/��"'/"'�� <br /> 9/D - <br /> PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF Fl%TURE OR REM <br /> � WATER CLOSET _ A/C—A/HANDLING UNITS <br /> 1 BATHTUB � FORCED AIR SYSTEMS <br /> �, LAVATORY(WASH BASIN) HEAT PUMP <br /> � 1 SHOWER UNIT HEATERS <br /> j _ KITCHEN SINK 8 DISPOSA� �[_ CLOTHES DRYER <br /> ; DISHWASHER rIANGE HOOD � <br /> ' LAUNDRY TRAY � WATER HEATER ` <br /> � 1_ CLOTHES WASHER _ METAL FIREPLACE/STOVE (-� " <br /> URINAL FIREPLACE INSERT l n \, I <br /> _ DRINKING FOUNTAIN Z GAS FIREPLACE I �"U <br /> _ FLOOR DRAIN GAS RANGE `� I� <br /> BACKFLOW PRCVENTER GAS PIPING � <br /> � SINK(SERVICE/BARIMOP/ETC.) � EXHAUST FAN /// <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIUN AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> � PROVISIGIJS OF UWS AND ORIDINACES GCVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GPANTING OF A PERMIT DOES NOT FAESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCdL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LA4'18.27 RCW AND 296.200 WAC. <br /> /� /• z�-�3 <br /> (�Sign ure ot nedContractor/Authorized Agent Da�q � <br /> I�a � <br />