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— r — + <br /> , <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> a�. X �Zcz-�cr <br /> 31TE ADDR SS PAHCEL TAX I.D.N PERA1n'x <br /> 3� � � z B�a - <br /> LEGA LOT NO. BLOCK TRACT <br /> DESG (,OC � lJ LYX S 1 U.� ��'C.� � <br /> OWNER / ADDHE S ZIP PHONE <br /> ��'�'�(P ��2K�' � �J�7 PA�K �2J�1�C.. �,���`��a '�/O I o�o.� <br /> TENANTNAME CONTACTNAME PMONE <br /> I ���,r ��c2KF �r��90 ioGs <br /> ADDRE� ZIP CONTR.LICENSE Nq <br /> CONTRACTOR JCSS— ¢ZS' 7$� �B'g/ <br /> PHONE �t G�� <br /> PROPOSEDUSEOFBUILDING I �7{Building Mechenical Addillon HEATSOURCE <br /> u PERMIT K{-(�Combinalion RI—( Plumbing WORK Alteration � Eleclric <br /> GARA(r�/�`�dR��"�� I TYPE y�Demolilion LJ Sign TYPE Naw Ges <br /> U Sprinkler RapairlMainl. Othar <br /> CONTHACT PRICE OF WOR � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �i vOo. <br /> WORKDESCRIPTION —r.� ���.�'� �=D� FDI.�I.. O�'I IOF� 1 ��0� �OT�"S• Y� F��15� <br /> cesrr�+c..�� Fc.o o R. 2Am E s�c i �2L . �O"'� d�T��^�`t���� •�STY��L -Gt.t ti—a2.ch <br /> �,�e s �,J-o P•�. �-m eo o,= �c,rr,✓Lc . �k�c, �s�,�Z...-�-n,.iu-�s� g�� <br /> �Lqrt�D UJvw(,�5 "t' w,�l+D aJf 'f �v on-'s �.J l.r-✓te. S�ryk'�� F�1 P2� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> A/C—A/HANDLING UNITS <br /> _ BATHT � FORCED AIR SYSTEMS <br /> = AVATORY (W�SH DASIN) �� HEAT PUMP <br /> UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER <br /> LAUNDRY TFAY WATER HEATER <br /> CLOTHES WASHER VE <br /> URINA� FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> DACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HERE[3Y C[RITIFY TIIAT I HAVE R[AD AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRU�AND COFRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING TH�S TYPE OF WORK W�LL BE COMPLIED WITIi WIi[7HER SPECIFIFD ViFREIN OR <br /> NOT. THG GRANTING OF A PERMIT DO[S NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR C�NCEL TI1E PPOVISION OF ANY OTHER <br /> OWNER OF T�HIS PROPERTY OTPF.RFORM THE WORNOFOP WHICH PPLICATION IS AOIADE AND I COMPLY WITH THE SOTA7E U AY TI1E <br /> CONTRACTORS LAW 18.27 RCW AND 29�.200 WAC. <br /> �,� }� � ��^ 3 �- G �_ � <br /> Signature ol Owner/Conlraclor/ ulhorized Agenl Dale v <br />