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I PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi', WA 98201 <br /> 425-257-8810- FAX 425-257-8657 <br /> SITE ADDRESS PARCEL TA� I.D.p PERMIT a <br /> 1�z. H e . Aq,���� I �d a�a -aa�- <br /> LEGA �f,_LOTI i /��/BLOCK I TP.ACT i <br /> DESC. E nL �'�2 'I�f7 ��•lorn_ {{ /� ���� G n (� <br /> OWNER ADDRESS ZIP PHONE � <br /> . C' s ,� �oC-2 I-1r<.f A✓e, ���ie� , G�JA c�r� Cyzs)3�7-ac� ' <br /> TENANT NAME CONTACT NAME PMONE <br /> 1 C3�o1 uis- I Zh� u-� � <br /> �7�mF nc n�rc✓Q I�q.� ��Son �4ZS) 317 -OiYk �r� <br /> CONTRACTOR H�•✓JCy P¢Cr ADDRESS ZIP CONTR.LICENSEp <br /> I �36N S7�`' �� l.1/ �8057 (7S3Q2 <br /> PHONE L�.i`� 7 �'13 -oqlG Ly.,�i u,;,:�.�� liJ/{ ,� , <br /> PROPOSEG USE OF BUILDING I''1 Building fl MeChanical Atldition HEAT SOURCE <br /> PERMIT Ip-c,(( Combination �� Plumbing WORK RL�( Alleration Q Electric <br /> TYPE u Demolilion LJ Sign TYPE u New �J Ges I <br /> L) Sprinkler(a ol hontls) U Ropair/Maint. U Othe. <br /> CONTRACT PRICE OF WORK fp$�jzS, �G CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 <br /> WORKDESCRIPTION �ji�{��rq,,,� rE.�cc���; <br /> 'I.P���uun.� Wul� �-c�/�'rin.� a,v�F� w^.�II L>C.✓L������ Cl.hl� <br /> —tii'W 'ffii�f� ����LI :ink frl Sc�w�p IC<<�/-�c/�, <br /> _ Nvw c.�b,nt4s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIICTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> �_ WATER CLOSET(TOILET) A/C-FVHANDLING UMITS <br /> 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 THAY W/,TER H[ATER <br /> CLOI HES WASHER NETAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT � <br /> _ DRINKING FOUNTAIN GAS FIREPLACE � <br /> FLOOR DfiAIN GAS RANGE � <br /> 6ACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN ( Ce:l���� <br /> �j OTHER= . .� _ OTHERT I <br /> _ .,, - y — I <br /> I fiEFEBV CERITIFY THAT I HAVE READ AND EXAMI.'JED THIS P.P?;ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFiOVIS:ONS OF LAWS P.ND ORIDINACES GOVERNING THIS TYPE OF WORK WILL dE COMPLIED WITH WHETHER SPECIFIED f1EREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VI(1LAYE OR CANCEL TIiE PFOVISION OF ANY OTHER <br /> STATG OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH!CH APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT RS LAW 1827 RCW AND 296.200 WAC. <br /> �� 7L��� I L l,r',ln1 <br /> Signalure of OwneVConiractodAuthonzetl Agerl Date <br /> � --- <br />