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PtRMIT APPLICATI(.,N <br /> I �. CITY �JF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �G � � � 425-257-8810- FAX 425-257-8857 <br /> 1 f'ohcr A� � , <br /> SITE ADDRESS I C_)�� '¢ I pARCEL TAX I.D.k I g.RMIT a <br /> �/ � C q /1 c– <br /> l .��: �Sf:)A.,Cr a 'lt 2 1 � �] � �� ?/J) <br /> IGGA L6TN0. BLOCK TRACT <br /> DES0.� � I 7 �y <br /> OWNER "— (C. C� Z. " C� 3 Z ^C.> � � U �- "T.i � <br /> �, ` ADDRESS ZIP pHONE <br /> 1 i � / /� <br /> L`�� j� � hU�lf�1 ��j � ' �- � � �..t-(. l,/ (..�);� \ ,�r ., / c _ . , <br /> TENANT NAME �-� � uN / �1� Z�7 � U�JJ <br /> CONTACTNAA!E PHONE <br /> \ rr � <br /> n� , . <br /> � �] � A1 �I �uv,l �yl��� zst •�6vo <br /> CONTflACTOR ' <br /> `; � -C �� ,� i ! r J,� �1 ADDRESS 21P CONTR.LICENSE H <br /> PHONE � C .� '�? C:. . ��n,�'�: / ,o(' �r _l - - ` 1 <br /> 1I, ,:J� ..� r .. iC <br /> 1Y�. �i[ J['� . ��1f. . �� � i � <br /> PRJPOSED USE OF BUILOING Building Mechanical I Adclition HEAT SOURCE <br /> Z��.': � s'�. �� I PEFMIT R COmbina�ion � Plumbing WORK � Alleration Q Electric <br /> TYPE D Demolition Sign I7vpe New �Jr Gas <br /> U Sprinkler fiepairlMaint. U Olher <br /> CONTRACT PRICE OF WORK CITY OF EVEftE"ff LOCAL SALES TAX CODE IS 3105 <br /> IIU,CX�U . Ac�✓ <br /> WORK DESCRIPTION <br /> �..?i�_ �. �r' J. 17 (.'� .r{% .S:r.,.�[ ��, n^. '/ �C �.�, :C/fn. : � ' w'�� <br /> J � � � ,��' <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR ITEM N0. TYPC OF FIXTURE OR ITEM <br /> -'� WATER CLOSET A/C-/+/HANDLING UNITS <br /> ��' BATHTUB 1 FORCED AIR SYSTEMS <br /> LAVATORY(WASH BAuIN} _ HEAT PUMP <br /> ! SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPi�SRL � CLOTHF.S DRYER <br /> DISHWASHER i RANGE HOOD <br /> I LAUNDRY TRAY _L WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN 1 GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(S[FVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ _ OTNFR__. OTHER <br /> I HEFEBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANJ KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING TI IIS TYPc OF'NORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PqE5UM11E TO GIVE AUTHORITY TO VIOLATE OR CANC[L THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCAL LFW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED B+'THE <br /> OWNER OF THIS PROPERN TO PEFFORM THE WOaK FOR WHICH APPIICATION IS MA�E AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 18.27 Rr CyJ A,N�D�96f-2pp�WpC\ <br /> i ; i i <br /> � i .i,,;'"'� . -' i 3%�/ %t <br /> Signature of Owp—�ContreCtof/AuthonzeU Agenl Dale <br /> / I/ <br />