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P�.RMIT APPLICATII,. N <br /> CITY OF EVEFtETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITe ADDRESS PAfiCEL TAX I.D.A P IT x <br /> I(�23 E'N6t,A►�D !�`!� 352�(0 �40� 700 -7 - <br /> LEGA LOTNO. BLOCK TRA i 2 F�'- �j '�"(/JP Z�I �•�� O T^ �Z <br /> DESC. p Y <br /> OWNER ADDRESS ZIP PHONE �(p – <br /> Jo� M�N� l� t{ Zo20q I�tcK�-qok1� �. aR .sEl►-'rC[F. w�} �aa o7 � <br /> TENANTNAME CONTACTNAME PHONE <br /> ���.�� �O� I�1I �� �ZS -'�� I — Q �'JO�T <br /> CONTRA�� �'��� 6'� ADDRESS ZIP CONTR.4CENSE� <br /> PHONE <br /> PROPOSED USE OF BUILDING p( Buiiding fl Mechanical Addition HEAT SOURCE <br /> PERMIT y{..(( Combinelion �_� Plumbing WORK Alteration R Electric <br /> LJI�j��� �}��Ly TYPE �j Demolilion IJ Sign TYPE New �iGas <br /> U Sprinkler RepairlMaint.�U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> ��F'Io06C. $/�EMEN�' ¢► ��`3T ��1� � � PP 4��-�C-x.6 <br /> �, Z►'p I�l,Oo(t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlJCTURE OR REM NO. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A/C–A/HANDLING UNITS <br /> �' BATHTU9 � FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> J_ KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> J_ LAUNDRY TRAY � WATER HEATER <br /> � CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAFUMOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> � — <br /> I HEREBY CERITIFY THAT I FIAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> IPROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> � NOT. THE GfiANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ISTATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH ThE STATE <br /> CONTRACTO�R,SnLA�W 18.27 RCW AND 296200 WAC. <br /> i <br /> ��Hd'�frt�p� �I �.0 3i 200 � <br /> I Signa o n r/ nlractor/Aulhonzed Agent ate ^ \ <br /> C� <br />