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+ <br /> F .:RMIT APPLICAYI'�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS L�J�/Z�� �,�/� PARCEL TAR I.D.� PER IT a <br /> Ir a31 i0�+no �(-�� �ao �OC�� 1 0� Uls uo �-Uo�v <br /> LEGA LOTNO. BLOCK TRACT / <br /> DESC. 15 UC�U' D" U(� F���-��T LSf/fiLS ��U '� <br /> OWNER ADDRESS ZIP PHONE <br /> ��,i r -�-C��,�qti� (023 � i�a�io ��i� `1�v�r �r�s-ya3 _�'Y�� <br /> TEiVANT NAME CONTACT NAME PHONE <br /> - J��E — N? 5 (u-7,�- ' 130�t �`753 <br /> CONTRACTOq �"'In 1� �nD`��G�qDORESS ZIP CONTR.LICENSE M <br /> ��b '/ <br /> PHONE <br /> PROPOSED USE OF BUILDING Building (") MeChanlCal Addilion I HEAT SOURCE <br /> PERMIT Combinalion �-� Plumbiny WORK Alteralion �r.r� Electri; <br /> TYPE DemalitiUn I � <br /> LJ Sign 7YPE New �j Gas <br /> Sprink'er RepairRdaint. I L� Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COUE!S 3105 <br /> WORK QESCRIPTION 7_ \ <br /> ,�DD�"rlJnl rJF 7�U F� �•vf�.J K�Tr.rF.n/ -r cr✓�-,J� ,eo�� 1 <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET NC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> �_ LAVATORY (WASH BASIN) I � HEAT PUMP �PJ.SJ IL?L� ) <br /> SHOWER UNIT HEATERS <br /> I�� KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> IZ� DISHWASHER RANGFHOOD <br /> LAUNDRY TRAY I �_ WATER HEATER CIti1 k.�7(.-lE.�J <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DFINKING FOUNTAIN . GAS FIREPLACE <br /> � FLOOR DFAIN � GAS RANGE <br /> I _ BACKFLOW PREVENTER GAS PIPING <br /> ' SINK (SERVICE/BAR/MOP/cTC.) � EXHAUST FAN <br /> i _ OTHER _ OTHER <br /> I = _ <br /> I <br /> '� I HEREEY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORPECT. ALL <br /> PpOVISIONS OF W WS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH V:r�THER SPECIFIED HEREIN OR <br /> NOT. THE GRANTI�IG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VI041TE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING COPJSTPUCTION OR THE PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br /> ; pWNER OF THIS PROPEFIY TO PERFORM THE WORK FOR WHICH P.PPLICATION IS h1ADE AND I COMP�Y WITH THE STATE <br /> i CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> 1\�� N� I/ <br /> l�i�`-'�^-"� / L� l.� � 0� <br /> SignaWre o q�n /Conl actodAuthon ea Agenl Date �� <br /> \ <br />