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P��.RMIT A�PLICATI�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 �G 2 3 Y�q �V'1d �G pARCEL TAX I.D.A� � PEPMiT t <br /> 'Fl�f O 2c104- ,�SOO 400 T O 0 � OACS LiG� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS Z1P PHONE <br /> Jc� n ot-►� � l c N- /6 2j �'�'Gc.�-ro �++�+ <br /> �vEwrr►r- �'02? <br /> TENANTNAME — I CON7ACTNAME PHONE � <br /> JklHF MSrt»�` <br /> CONTRACTOfl��t n ��i c N ADORESS " ZIP CONTR.LICENSE N <br /> Dw✓�1� ' <br /> PHONE <br /> PROPOSED USE OF BUIL�ING Building Mechanical Addition HEAT SOURCE <br /> PERMI7 Cambinalion Plumbing WORK Alteration R Electric <br /> TYPE Derholilion Sign TYPE New �j Ges <br /> Sprinkler RepaidMaint. U Other <br /> CONTRACT PHICE OF WORK CITV OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> WORK DESCRIPTION <br /> T-c-�M- Oc�r ✓ G�tx_- P�i�l' <br /> . <br /> — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OH ITEM NO. TYPE OF FlXTURE OR REM <br /> WATERCLOSET _ A/C—A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES ORYER <br /> DISHWASHER _ RANGE HOOD <br /> LPUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIR[PLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICFJBAR/MOP/ETC.) EXHAUST FAN <br /> I _ OTHER _ OTHER <br /> I — <br /> I HEREBY CEFITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COAPECT. ALl <br /> � PROVISIONS OF LA�VS AND ORIDINACES GOVEPNING TH1S TYPE OF WOFK WIIL BE COMPLIEU WITH WHETHEF SPECIFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRI'�TION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZEU BY TNE <br /> OWNER OF�T OPERTY TO pERFORM THE WORK FOR'vVHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR CTORS 78.27 RCW AND 2 6200 WAC. <br /> s"/r/o1-- <br /> Signalur wnedContractodAW onzed Agent ate <br /> � Cj -OO <br />