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P�r�MIT APPLICATIC�d <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> cr_-s�i9��a��l <br /> SITE ADDRESS pARCEL TAX I.D.k PEpM17 K <br /> �� �ecics S -oa �-a �FoS� ��'j�—Da'� <br /> LEGA LOT NO. BLOCK TRAC7 E'yS�t /a p ��Of <br /> DESC. f�� QJ.eLIC ��"uj VI�W <br /> OWNER ADDRESS -� ZIP PI10NE <br /> lo �jG£ .S�i �w s � �- y�s 3Y� 3/6 � <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR _ ADDRESS LP CONTp.LICENSEN <br /> PHONE <br /> PROPOSED USE OF BUILDING pERMIT I--( Spr nklgation � Pl9mb ngal W�RK B Repa r/MainL MEAT SE�RCC <br /> TYPE H Demo�ition Si n TYPE New � Gas <br /> �� L� omer <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION �� �� ��„�� �C,JPK Cp1GtcCC�lO <br /> �you � k���ss <�arc. Se•f � / ✓.JkF�co+.��,5 xf <br /> G�,;. -en �-� c • /2{ pr� rrL ��-F+�- £ �v c..a��rsLf ��,�-r���� � s���uli <br /> aio� .L,-f-c � , /�,ou s � • a �s c�wvez �� � 6•i-s �r 2< f�Cn�4� �c rc�PSL �•ftK� <br /> S V� c.c.�CK/ACE <br /> PLUMBING MECHANICAL <br /> i NO. TVPE OF F�XTURE OR ITEM NO. TYPE OF flXTURE OR REM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> I _ LAUNDRY TRAY _ WATER HEATER <br /> I = CLOTHES WASHER = METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> � DRINKING FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> I = BACKFLOW PFiEVENTER _ GAS PIPING <br /> SINK (SERV�CE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTH R _ OTHER <br /> � > Qii r� rr��n�, / _ <br /> ���r�� ('•� — <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OFIDINACES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTFiACTOR LAW 18.27 FiCW AND 296.200 WAC. <br /> _/� � � v��.T/2�°Z <br /> Signalure ol O erlContractor/Authorized Agent Date l� <br />