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P�RMIT APPLICATIC.�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE A�ORESS �f'� � PARCEL TAX I.D Jfs PERM'I�T aY� �'9 <br /> oZoZO O f- dG�L r/ �✓I. F OO'�� 7 O '� �e 3I� OIO" DD �Y�+ -,•- `• "�A ! <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> ��,.��./ ,�s r.:�7-�,z s��s c���s A� E�.�'��� <br /> TENANT NAME CONTACT NAME PHONE <br /> /� � <br /> CONTRACTOR CJO`� .P��J�T, .C�j� ADDRESS Pe. �px /� 9 S� ZIP CONTR.LICENSE N <br /> PHON EJl� C�OS" A P«}4! Q <br /> �y.����.z.�"8•3L6 7 ww <br /> PROPOSED USE OF BUIL�ING Building f"1 Mechanical Addilion HEAT SOURCE <br /> /� PERMIT�Combination �_� Plumbing woRK R nlieration (� Electric <br /> / ,G��� 7YPE Demolilion LJ Sign TYpE D New D Gas <br /> L��G Sprinkler U RepairlMnint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERET'�LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION <br /> /���o - Gx :s :� ,��� . �-Z 22 �ti���v�c <br /> D �.4S�.o.iC �.�� R`�.en?.'` <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A!C—A/HANDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> I _ DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> r I _ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> ! _ FLOOR DRAIN _ GAS RANGE <br /> ' BACKFLOW PREVENTER _ GAS PIPING <br /> SWK(SERVICEiBAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER <br /> — — — <br /> �� :HEREBY CERITIFY THAT I HPVE READ AND EXAhtINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COM11PlIED WI�iH WHEfHER SPECIFIED HEREIN OR <br /> ' NOT. THE GRANTING OF A PEFlMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STAT LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> , OW E OF THIS PROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO T ACTORS t�1W 1827 RCW AND 296.200 WAC. <br /> ' J�— c4=.Zov.2� <br /> Si alure o� ner/Co dAuthorized Agent Date <br /> � <br />