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r --_ - <br /> ! Pr��l�'{�T APPLIC,4TlC�iV <br /> -, � CITY OF EVERETT PERiIAIT SERVICES <br /> 3200 CE:DAR STREET, EVERETI', VJA 98201 <br /> 425-257-8810 — FAX 425-?_57-8857 <br /> , �1�� <br /> SITE ADDRESS - . PARCEL TA�( I.D.rk � • PERMi7 a <br /> _._..---------' <br /> `-' /�/� �r C��e�- Oa� <br /> LEGAL LOT N0. BLOCK TR T p <br /> DESC. 7 S� �� O�Q � <br /> OWNER AODRE55 ZIP PHONE <br /> y� � � �^° F�x � °`� �j � 1 r��1 z 9,r'�J' <br /> 1 �� �w�l,•pr.frr n� � �(/v�> > <br /> � ,� TENAt�i'NAM[ , I CONTACT NAPAE PHONc <br />��'! CONTRACpTO,�j C ' �,� ADDRESS ZIP CONTR.LICENSE N <br />� d� I"�K !—+��v�f�,frJ —La�_ f�� i�01� ��AV ���� <br />��y��' I PHONE L_t'P/'t'�f �dr�� �✓✓�ENL '.�U1L�TC_ <br /> ..a,�' '-�. — <br /> �� � PROPOSE�USE OF BUILDING n,( Buildlflg Mechanical Addi�lon HEAT SOURCE <br /> ^ I PEfiMIT �y�! COmbinalion R�../ Piwnbing WORK R�,/ Alteralion Eleclric <br /> S�—� TYPE u Demolition U :ign ITYPE ,�y New � Gas <br /> L� Sprinkler 'U Repair/Maint. Olher <br /> CONTAACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CDOE IS 3105 � <br /> WORK�ESCRIPTION <br /> �o.�,�-u�� s�� 3�15r� a-� yo ��) <br /> PLUMBING MECHAPdICAL <br /> N0. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> .3 _ WATER CLOSET A/C—A/HANDLING UNITB <br /> Z BATHTUB �_ FORCED AIR SYSTEMS <br /> _� LAVATORY(WASH BASIN) HEAT PUMP <br /> J_ SHCWER UNITHEATEHS <br /> i KI7CHEN SINK& DISPOSAL �_ CLOTHES DRYER <br />.., _L DISHWASHER ( RANGE HOOD <br />' ' :�' � LAUNDRY TRHY � WATER HEATER <br /> � � I CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br />�'i'��,� '� _ DRINKING FOUNTAIN � GAS FIREPLACG <br /> .+ Ii � _ FLOOR DRAIN 1_ GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> .�. '� _ SINK(SERVICFJBAR/MOP/EiC.) EXHAUST FAN <br /> ``j � _ OTHER OTHER <br /> � — — � — — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AIJD CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WIIL BE COh1PLIED WITH WHETHFR SPECIFIED HEREIN OR <br /> NOT. THG GRANTING OF A PERI�IIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL i HE PHOVISION OF ANY OTIiER <br /> S7ATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFOR6IANCE OF CONSTAUCTION. THAT I AM AUTF;ORIZED BY THE <br /> OWNER OF TH!5 PROPERN TO PERFOFM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLI'Wli li THE STATE <br /> - RACT R 1627 RCW D 296200 WAC. <br /> �� ����-�-�" `'//�� L <br /> Si natwe o wn r�ontractor/Authonzed Agent � Da/ te ' <br /> I ?� <br /> .s� � �� � � � T �_� <br /> � #, . 7'�:. � ,>� � �'�f , �� �5 <br /> �� <br /> �� �� �i� �'� ut� � � k� ��'` <br /> , F�'�' � .i: � t 1�� �)F � a `;�i, x ap*�;,�..'• <br /> g �� . . � �a ,€i.a <br />� ✓ � ' `:f-,ebrY$ s '�' ih 7.,J�'" <br /> k . �.+ �i <br /> pv; �e <br />