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PERMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> G�931/-�3% ���G� <br /> SITE A�FESS PARC L TAX I.D.• P RMR M <br /> � `�3a C ran� �,,� -¢3/G/ d � 2�3 CY>2 <br /> LEGA LOTNO, BLOCK TRACT J � ) <br /> DESC. � y � � y --��f o��OhC� -EC�f��N <br /> OWNER ADDRESS ZIP PHONE <br /> ll� ,�a��� i�o�r �c.�e l er ai3a �r`n� �ue y�ao/ �2s 33993ya <br /> TENANTNAME I CO�NT�*NAME PMONE <br /> •�' �v�`� 1�'�. !-�,.� �,�sw� �)769-7Z�v9 <br /> CONTRACTOR AD ESS aP CONTR.LICENSE• <br /> �1 �/ ��,��� i��a ��� s�N� 4�58' �1i�i��o990� <br /> PHONE 2eb 76q �2�p7 � s'W��S �tt <br /> PROPOSED USE OF BUILDING J7(Buiiding I"'1 Mechanical I"1 Addit�on HEAT SOURCE <br /> PERMIT T�'rombination K Plumbing WORK �_� Alleration Electric <br /> 7YPE ,�q Demolition �, Sign TYpE �.l New Qas <br /> U Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK �� �G � CITV OF EVERE7T IOCAL SALES TA%CODE IS�705 <br /> �J <br /> WORKDESCRIPTION ��� hOWQ QMd/�fL �� vs.f0r.� '�WN ON ! <br /> � / 7 , repl�ce �$ M�r <br /> �o�, ,kiN, lo►„t�r l�e eK�o Kvw .�.'}, �ni ���f�,•� �,ew b�� ���s <br /> btc�/�ria,' �n��A� �� C23a fL!'+� af kA ►'�e�+ V+�r o►�k' �198'fLf�F). <br /> PLUMBING MECHANICAL <br /> I NO. TYPE OF FlXTURE OR ITEM NO� TYPE OF FlXTUNE OR ITEM <br /> WATER CLOSET A/C—NHANDLING UNITS <br /> 1 BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> � SHOWER UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL J_ CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> � 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 /> BACKFLOW PREVENTER � GAS PIPING <br /> �_ SINK (SERVICElBAR/MOP/ETC.) 2 EXHAUST FAN <br /> OTHER OTHEA <br /> � • <br /> II HEFEBY CERITIFf THAT I HAVE READ AND EXAMINED THIS APPL�CATION AND KNOW THE SAME TO 8E T�UE AND COFRECT. ALL I <br /> PROVISIONS OF 1�1W5 AND ORIDINACES GOVERN�NG THIS TYPE OF WORK WILL BE COMPLIEO WITF'WHf_TNER SPECIFIED HEFEIN OR <br /> �' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL TF�E PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING ONS RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHURIZ�:D BY THF I <br /> OWNEF OF THIS PROPERTY TO PE R HE WORK FOR WHICH APPLICATION IS MADE AND i COMPLY WITM TNE STATE <br /> I CONTRFCTORS W .27 RCW AN 9 00 WAC. I <br /> az <br /> Signawr o � r, tractor u nzed Agent ate �/3 <br /> � <br />