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F�RMIT APPLICATIvN � <br /> i <br /> �ITY OF EVERETT PERMlT SERVICES �� <br /> 320G CEDAR STREET, EVERET'', WA 98201 <br /> 425-257-8b1�- FAX 425-2�7-8857 <br /> SITE PDC�RESS PARCEL TAX I.D.# � PEF;diT a <br /> �o �E � �J �c c�' oc�4'ra3- o00 - 007— cb co3 0 3- ora <br /> LEGP LOTNO. BLOCK TRACT <br /> DESC. L�iT �,' � _ _Lmnv� Pu�T t�c�i„� r� Sne+�1. C'e� ��� i� Qnc�SS <br /> OWNER A� RE55 ZIP PHONE <br /> Cc�u�su�; --;��.�7-. Inl� � t' o.�,X3oos EdC,2�rr `I��o3 �z��.��-���G _ <br /> TENANTNAME I CONTACTNAME PHONE � <br /> � i Ca�S l�'�u��1 !;�-.:�6-7�/6 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE p <br /> �iftc�� �crn-c. ��Ic. �.u, g�c ,3�os- eu�r wfl `r�a� ,. <br /> PHONE cSr u_�c�o qq►�t <br /> N-zs-3�•�7�b <br /> PRj POSED USE OF BUII.�ING � BUildi�g � Mechan9al n Addition HEAT SO'1RCE <br /> S� GeE �r�r,u�y PERM�T Combination Plumbin WORK M� Alteration � Electric <br /> TYPE D2rholition Sign T'PE '�r New Cas <br /> '��� � Spiinkler Ll Repair/Maint. J Other <br /> CONTRACT PRICE OF WORK /// r�/ — —� CtTY OF EVEFlEff LOCAL SALES TAX CODE IS 3105 <br /> !O <br /> WORK DESCRIPTION �C�y [�T. �'(^f4 (� �71'Hl1/ �J����`(� <br /> �b�Z a� FfCu'3c / <br /> 3� �j 6��ti <br /> IPLUMBINf6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATERCLOSET �-�' A!C—A/HANDLINGUNITS <br /> 2 B.4THTUB i' � FORCED AIR SYSTErv1S <br /> � LAVATORY (WASH BASIN)�;-. _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> / KITCHEN SINK 8 DISPOSAL �_ CLOTHES DRYER <br /> �. _L DISHWASHER � RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER � <br /> j � CLOTHES WASHER _ METAL FIREPLACE/STOVE ' <br /> ' _ URINAL FIREPLACE INSERT <br /> DNINKING FOUNTAIN . Z GAS FIREPLACE <br /> FLOOR DRAIN [ GAS RANGE <br /> i _ BACKFLO'N PREVENTER � GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN %J// <br /> OTHER O?H[R <br /> I — — — <br /> i <br /> I HEFEBY CERITIFY THAT I HA\'c READ AND EXAMINEU THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORpECT. A�L <br /> PROVISIONS OF L1WS AND G?ID!NACES GOVERNING THIS T'PE OF�VORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEAEIN OR <br /> '� NOT. THE GRANTING OF F,PERMIT OOES NOT PRESUtdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEP <br /> STATE OA LOCAL LP N REGULATING CJNSTRUCTION OR THE PERFORMANCE OF CONSTAUCTION. THAT I AM17 AUTHORIZED BY THE <br /> OWP!ER OF TI dS PF�PERN TO PERFJRM THE'NORK FOR WHICH APPLICATION IS bIADE AND I COh1PLY WITH THE STATE <br /> CONTRACTOR V.W 18.27 FCW ANC 296200 WAC. <br /> ,� � /���.,, ✓�`��-03 <br /> SignaWre ol OwnedCoNractodAuthorized Agem Dale <br /> i �L <br />