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r � <br /> � <br /> P�RMIT APPLICATIl:�N <br /> E,, CITY OF EVERETT PERMIT SERVICES <br /> 3200 CCDAR STREET, EVERF'fT, WA 98201, 425-257-8810 <br /> SITE ADDRESS pARCEL TAX I.D.k PERMIT# <br /> —folo s. 3��. �,✓� 2 `� oSi o �� � oo ' Z � �� / <br /> LEGAL LOT NU. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS i PHONE <br /> caU G���P � <br /> -- ' �� <br /> TENANTNAME CONTACTNAME i <br /> I PHONE <br /> ur� `T'Y 6C�o�� M ���c � R ��t1E `C (z"b� 3q1 -3 (3� <br /> i <br /> CONTRACTOfl j qDDRESS CONTI�. LICENSE k <br /> �r1ti�.D S"jS'rciNS �r�/C. I �02 � S� K �iCKi�iAi ���f I <br /> PHONE SJ�r� � i�' �o� UN TE SL <br /> (:Z°�� i s� nT��� �� , q�, i i 1� cv � 6 <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT R Combination �Plumbing WORK �Alteration �Eiectric <br /> �E f��� TYpF. D Cemolition Sign TYPE New Gas <br /> U Sprinkler Repair/Maint. Other <br /> CGNTRACT PRICE OF WORK � ( J v � °� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION �tloCnT[- (1� �It.AT P�"`P� A9D (2� (' �(2E/ SmeKE 1��� ^I�S . <br /> A)) /Jtti1 � �cr�•JuAr i o i e ��SE25 � 6R � ��ES . ADD (� ) � <br /> QLEN�w. N,uvNr c� Rc�,Z �T� c�,J FA.J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET ,��p�� _ A/C-A/HANDLING UNITS <br /> _ BATHTUB e(j Pc`� _ FORCED AIR Sl'STEMS <br /> SHOWER Y(WASH BASIN) ��PQ _ HEAT PUMP <br /> _ UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL (� �� _ CLOTHES DRYER <br /> _ DISHWASHER C� ����, _ RANGE HOOD <br /> IAUNDRY TRAY -1 � WATER HEATER <br /> _ CLOTHES WASHER ��� �� � _ METAL FIREPLACE/STOVE <br /> _ URINAL �\�' _ FIREPLACE INSERT <br /> = DRINKING FOUNTAIN ��i � _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENT.ER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER � OTHER h'flF; ��. T,r W vRK <br /> — � N �Rr S•yoKe OA�,PERS <br /> 1 HEREBY CERITIFY THAT I HAVE READ P.ND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACER GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLP.TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE PGRFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPF.RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AIJD I COMPI.Y WITH THE STATE <br /> CONTAACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> / 9��Z <br /> Signa ure ol OwnedC NraclodAuthonzed Agent Date <br />