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�- ERMIT APPLICAT`, JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, N!A 98201 � <br /> 425-257-88i 0- FAX 425-257-8 57 � <br /> c.�-�� �0� a��- o� � <br /> SITE ADDRESS PAHCEL TAX�+.D.# Cf$lf 3Z,��5'�r ERMIi <br /> lSo� �du � � 0629SOD�/$� 94'r�'/ I� ���(� <br /> LEGAL LOT NO. BLOCK TF7ACTi� f / �p � <br /> DESC. � ( <br /> OWNER J <br /> � ADDRESS ZIP ONE <br /> ��a.����l0��7�-/� �/ �'� ,or� �,r�y�fi/D B �d����l 3e3 0 �3 <br /> TENANT NAME �–� I CONTACT NAME / PH N.a E <br /> 7�1eN19��iq'' L 9n�� /r�,�/��Z/J� !,' x S'3'3 <br /> CONTRACTOR ADORESS 2Ip CONTR. LICENSE N <br /> PHONE T(�� <br /> PROPOSED USE OF BUILDING I Building Mechanical Addition HEAT OURCE <br /> /� PEqM17 Combinalion � plumbing IWORK �Alteration Elzctric <br /> QII /� TYPE Demolilion Sign TypE N�n �Gas <br /> �'r� � y� Spnnklar Reoair/Mainc `L� Other <br /> CONTRACT PfiICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK OESCRIPTION ` � <br /> e�ri s��c��a i� o��� �v,�.eh4�� a, rti d o� , �, <br /> C9�C��J� �ti� cri�f��r Gvz// canf yavlo� a��/aSto�/L��S � (�/py�C <br /> PLUMBING MECHANICAL <br /> iNO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FIXTURC OR ITEM <br /> _ WATER CLOSET _ A/C–A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> I _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SlNK& DISPOSAL _ CLOTHES DRYER <br /> ' _ DISHWASHER _ RANGE HOGD <br /> ' _ LAUNDRY TRAY _ WATER HEhTER <br /> I __ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLAC!= INSERT <br /> _ DRINKING 'rOUNTAI�I _ GASFIRE�LACE <br /> ' _ FLOOR�RAIN _ GAS RANGE <br /> �, _ BACKFLOW PREVENTER _ GAS PIPING <br /> - _ SINK (SERVICElBAR/MOP/ETC.) _ �XHAUST FAN <br /> = OTHER — I <br /> _ OTHER <br /> I HEREBY CERITIFY T'. ' � "'/E qEAD AND EXAh11NED THIS APPLICATION AND KNOW THE SdME TO BE TFUE AND CORRECT. ALL <br /> PROVISIONS OF L�"'"� �.,DINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GRAN'. � - _Hh11T DOES NOT PRESUME TO GIVE AUTNORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LA'e .�.,JL4TING CONSTRUC710N OR THE PERFORh1ANCE OF CONSTFUCTION. THAT I AM AU7HORIZED BY THE <br /> OWNER O THIS PROPERTY TO P FORht THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATe <br /> CO 18 7 RC ND 296.20 FC. � � <br /> igna r � r rodAu horized Ayent Dale � <br /> ��2 <br />