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P� .�MIT APPLICATIC� : <br /> CITY OF EVERETT PERMIT S�FiViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-SS10- FAX 425-257-8857 <br /> � �30� - �/3 <br /> SITE ADDRESS PARCEL TAX I.D.q PERMIT s <br /> 3��� ��/"1� c� o '� -D 3`7�tx� -� <br /> LEGA LOT NO. �BL7O�C}K� TRACT,�1�� �L <br /> DESC. �� / C F�:-•�G i/ l/'T/ti Gt� � � �� �� <br /> OWNER A�DRESS ZIP PHONE <br /> � c��� -�� P�v:,�,ie �.x�2- t�: t�v��� 2��zc�i <br /> TENANT NAME I CONTACT NAME PHONE <br /> ��1� W1c.K I+ANI qZS �, SZ ' 27Fs�' <br /> CONTRACTOR A�DFiESS ZIP CONTR.LICENSE p <br /> p�:tJrU� <br /> PHONE <br /> PROPOSED USE OF BUIL�ING Building I� Mechanical Addition HEAT SOURCE <br /> PERMIT R{.�( Combination 4_� Plumbing WORK Alieration Electric <br /> � TYPE u Demolition L� Sign TYPE New �Gas <br /> L)�� L� Sprinkler RepaidMaim. L� Other <br /> CONTRACT Pfi10E OF WORK CITY OF EVERETT IOCAL SALES TPX COOE IS 3105 <br /> WORK OESCRIPTION <br /> _ 4���.r�cc cxc��ti.�i i�c,i�cc1 2cr�, - � �D <br /> - �.1 cv.� ��icJdcl,�{ /�A�1�;1 x) El . <br /> � PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i <br /> WATER CLOSET A/C—A,'HANDLING UNITS <br /> I _ BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHES 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/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> i ' <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AtJG KNOW THE SAME TO BE TRUE ANJ COFRECT. ALL <br /> PROVISIONS OF I.AWS AND ORIDI:JACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1IE TO GIVE.4UTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OF LOC.�L LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE'NORK FOR WHICH APPLICATIOPJ IS MA�E ANO I COMPLY WIThI THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND� .200 WAC. <br /> � <br /> 7' /�� S ^ <br /> Sign re o OwnedContrac!odAut onzed Agenl Date / ,\I <br /> �/L <br />