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RcRIViiT APP�ICAT"�N I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADORESS pARCEL TAX I.D.# PEANIT x <br /> 33 is K�-o�.:�- /�ve. OG4375784oU800 ( � va�� -or7 <br /> LEGA lOTNO. BLOCK 7RACT „ <br /> oEs�. g � � � sa- PI�.+ �� ���:�+-t 9�� ;S;a�. N ", �,,,�. a Pj . so <br /> OWNER AODRESS LP PHONE <br /> �av � c�I T. Icr�� l� 33 , 5 Kro.,.cr �'-' <br /> Q�Gv�1. o- �` . I Grri � � L vcro-F} , I,JA 9s2U I C425� 303-9634 I <br /> TENANT NAME CONTACT NAME PHONE <br /> I ��v,� �crn � � �4zS� 303-9C,'34 <br /> CONTRACTOR ADDRESS <br /> ///� ZIP CONTR.LICENSE A <br /> PHONE �jr-/`^��-� <br /> PROPOSED USE OF BUILDING rL�/ p�Uildi�g DAechanical Adtli�ion HEAT SOURCE <br /> I PERMIT � ) Gombinalion R Plumbing WORK �qlleration n Electric <br /> S�„/+� TYPE g Demoliticn � Sign ITYPE New � � Gas <br /> � � Sprinkler Repair/�daint. I LJ Other <br /> CONTRACT PRICE OF WORK 2 �1Y� qTY OF EVERETT LOCAL SALES TAX COOE IS 3�✓5 <br /> �VU� <br /> WORK DESCRIPTION 1 <br /> �rlslc-ti �. X15�1�q �'0. 1 `O..T �10.rC-�l' (�O�l 1n11� CL 4tiblC.' I�OC�T . <br /> ) J JI J <br /> Mud �� hOv'>` rvo'� '�u ��c..c� w �� v1 ew g �—r-e<g� r'c�0 � � <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ A/C-A/HANDUNG UNITS <br /> _ BATHTUB , FORCED AIR SYSTEMS <br /> i = LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN S�NK 8 DISPOSAL _ CLOTHES DRYER <br /> I _ DISHWASHER RANGE HO00 <br /> I = LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> i _ BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAWMOP;ETC.) EXHAUST FP.N <br /> I _ OTHER OTHER <br /> � _ — <br /> I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SA61E TO BE TRUE AND CORREC7. ALL <br /> . PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORH WILL BE COMPLIED WITH WH�HER SPEC�FIED HEREIN OR I <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AU7HORITY TC VIOWTE OR CANCEL 7HE PROVISION OF ANY OTHER I <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. TNAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPEPN TO PERFORM THE WORK FOR WHICH APPUCATION IS MADE AND I COMPI.Y WITH THE STATE <br /> CON7R CTORS LAW 1827 RCW AND 296200 WAC. <br /> � � J ������ ��i�,/�� � <br /> I Signature uf OwnerlConlractor/Aulhonzed Agern pa�e 1 a <br />