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I � ERMIT APPLICA�� �►,� <br /> CITY OF EVERETT PERMIT SEP.'JICES <br /> I 3200 CEDkR STREET, EVcRETT, WA 98201 <br /> i� 425-257-881 q - FAX 425-25�-8857 <br /> _ ��Q�r�a6Z� <br /> SITE ADDHESS PARCEL TAX I.D.# f_ PERMIT x <br /> � �� o�8ovy�va000a �its-o��-- <br /> LEGA LOT NO. BLOCK TAACT �— � <br /> DESC. <br /> OWNER��\l,���IC�yY�Y11 '�-ly• S���JI" S S��"' 1(�I ZIP PHONE <br /> \ ���Cl �� ��G2a <br /> 'n^�r�S�WR <br /> TENANT NAME �����n I CONTACT NAME� PHONE <br /> vohn acec� <br /> � 253-92�0 22�0 <br /> CONTRAC70R Z�O� �Q I <br /> Pat-riot FreProter`�'1�n AD�RESS T� �e � ZIP CONTR. LICENSE k <br /> PHUNE /�2y Par�iF�oa9cF <br /> 2_53 -q2C��22�0 <br /> PROPOSED USE OF BUILOING pUilding MeChanlCal `�Addilion I HEAT SOURCE <br /> PERMIT Combiaaticn R{--( Plumbing Y.�ORK I�� Atleiation Q Electric <br /> TYPE �Demolitio�. �J Sign ITYPE �_� New �J Gas <br /> _ Sprinkler LJ RepaidMamt. I U Clher I <br /> I —CONTRACT PflICE OF WORK �j�� CITY OF EVEREIT LOCAL gqLES TAa COOE IS 3105 <br /> NOHK DESCRIPTIOP! / / ` <br /> �k-K�iG� P �J��� 4�c.�- ��,y��'— I� l�L'^' �hl�t' S�0.C.t.. . <br /> �'�/ / <br /> r� //�Q� I <br /> '� PLUMBING `J ' <br /> MECHANICAL <br /> NO. TYPE O�FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LA�/ATORY(WASH BASIN) HE.1T PUMP <br /> _ SHOWER UNIT HEATL"RS <br /> _ KIT,CHEN SINK& DISPOSAL CLOTHES DRY[N <br /> I _ DISHWASHER _ RANGE HOOD <br /> , _ LAUNDRY TRAY WATER HEATER <br /> I _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> I _ DRINKING FOUNTAIN , _ GAS FIREPLACE <br /> _ FLOOR DRAIIJ GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> � _ SINK(SERVICE/BAR/MOP/ETC.) __I EXHAUST FAN <br /> _ OTHER_ OTHER <br /> 1 - - _�I F rP 5��rlKhr� <br /> I — , <br /> I HERE�Y CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION APID KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER S?ECIFIED HEFEIN OR <br /> P�OT. THE GRANTIIVG OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORIN TO VIOLATE CR CANCEI THE PROVISION OF ANY OTHER <br /> ;iTATE CR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANC=OF CONSTRUCTION. THAT I AM AUTHORIZED BY l'HE <br /> GV:'NER OF 7HIS PFOPERN TO PERFORM THE WORK POR WHICH APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br /> �!TRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> i�,,��, lll�/�. -- i�%s1�3 <br /> Signalure ol Ow edContractodAuthonzed Agent U2te '/ <br /> v <br />