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, <br /> � � PEr�NIIT APPLICATIQN <br /> +�' CITY OF �VEI�E:TT PERMIT SERVICES <br /> 3206 CEDAR STREET, ;"dERETT, WA 982C1, 425-25'-8810 <br /> SITE ADDRESS i PARCEL TAX I.�.# PERMIT p <br /> � � / ,_ � In�.�u�� �, �'�� GC� � � �s -o� � -�o GG/�9�O1 <br /> LEGAL LOT NO. ' i BLOCK TRACT <br /> io�sc. I I _12 3 �+lo Lvc. �L , �is(c;N � L' Vu� S ��cG e �.G <br /> , flW�ER A�DRESS ' PHONE <br /> � <br /> � ��I__ �/_it �����i.l�uU� � �l '�� ���'�� � �� � � C o i <br /> �2, Z�Y� ��� i <br /> TENANTNAME I CONTACTNAME � � PHONE <br /> I_�J I <br /> - ����t � <br /> CONTRACTOR ADDRESS j CONTR. LICENSE p <br /> PHONE � <br /> � <br /> PROPOSED USE OF BUILOING Building r , �yjechanical Adtlition HEAT SOURCE <br /> [;i���; �'r��,�i� (, ��, »�I - PERMIT R Combination � Plumbing WORK �ji aiteration D Eieanc <br /> TYPE D Demolilion Sign TYPE D New [3 Gas <br /> U Sprinkler U Repair/Maint. U Other <br /> CONTRAC7 PRICE OF WORK �+�p0 v. v a GTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION Q(��l `I7 �.�,��GL {-t� I �'� It-L� 2� �n�'�'( I"z-i I�� 1 I �� <br /> � I , (���1 l�a�-Z� <br /> Qd({ IGI���[i:1c� ���h� �{Z, �J��tl �Icci'-' <br /> Yi i�ti�o��< � �<��7 ��t «� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATERCLOSET _ q/C-A/HANDLINGUNIT$ <br /> BATHTUB _ p�aCED AIR SYSTEMS <br /> I �_ LAVATORY(WASH BASIN) I _ H[AT PUMP <br /> SHOWER _ UtJIT HEATERS <br /> I KITCHEN SINK& DISPOSAL � CIOTHES DRYER <br /> _ DISHWAS;iER _ RANGE HOOD <br /> LAUNDRYTRAY� � VJATER HEATER <br /> i CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ UFINAL FiREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN I GFlS RANGE <br /> ._ BACKFLOW PREVENTER Z GAS PIPING <br /> _ SINK(SERVICElBAR/MOP/ETC.) � EXHAUST FAN �0 <br /> = OTHER _ OTHER ��f ' <br /> i �� � _ .�� <br /> � �/-' <br /> I HEREBY CERITIFV THAT i HAVE REnD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COqRECT. ALL <br /> PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL 0E COMPLIED WITH WHE�HER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A pERM1T DOES NOT PRESUIdE TO GIVE AU7HGRITY TQ VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> �� STATE OR LOCAL LAW REGULATING CONSTRUCTdON OF THE PERFORMAhCE OF CONSTFUCTION. THAT I AM AUTHOqIZED BY THE <br /> iOWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS M.4DE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ,�,�b1,�,� l: �'1.���,6 ✓� 1 - � \ -'C � <br /> Signatule of OwnerlConlractor/Authonzed Agent Date �/ <br /> 1 L <br />