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� ERMIT APPLICAT:JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. q PERMiT n <br /> �9 o kz �o� � - -oz� - oo coa � �-o� <br /> LEGA LOTNO. BLOCK TflACTC I,� <br /> DESC. Z7 �y' � � o"'S V a.� �\V . 1 \ <br /> OWNER ADORESS ZIP �HONEL�_ ZC��-�S�� <br /> 1�av �. O�-�o ySS3 - 5 z..\ ,�,., J�1 � 54,��. �X�uS «��. 2a� �qo � u z� <br /> TENANTNAME CONTACTNAME HONE <br /> J�Y,� l7'�to 5��+�n o�6 wk'• 2��• �b - ' � '7 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> ��o+v�lo W naf' .SC?N�. <br /> PHONE ��, �y�- 4b3'`�9S 1 <br /> 4 '' <br /> PROPOSED USE OF BUIL�ING ` Building echanical ddition HEAT SOLLLURCE <br /> PERMIT Combinalion Plum6ing WORK teration �lectric <br /> TYPE Demolilion Sign 7YPE ew Gas <br /> Sprinkler RepairiMaint. Other <br /> CONTRACT PRICE OF WORK ������ � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION Z`i.w� .e,.t y�o �n�y\ Lo.�./.�r� G, �L, P%(r�.� !J�o�'V`� �1 C'C11no�+Y s' <br /> CC\oCU `'i. 0��+.+'^��� 'P , W .r.n ��a \\ d-oo�• 0. �#s.u�ql:dn W�l\\ • <br /> 1' � �' �� � �..,- <br /> �1aw ��S�t\n"�^arl �A�.J� W .��T,US ; YVa+.+ a�:,, wc� . <br /> � ' ?/ X/�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M N0. TYPE OF FIXTURE OR ITEM <br /> / WATER CLOSET A/C-A/HANDLING UNITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> _' LAVATURY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 3 DISPOSAL C�OTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> I = LAUNDRY TRAY J — WATER HEATER I <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I _ URINAL _ FlREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN ��,L GAS RANGE <br /> _ BACKFLOW PREVENTER ��L G�S PIPING <br /> i ._ SINK �SERyICE1�fUMOP/ETC �. �_ EXHAUST FAN <br /> ; _ p�X Sy\o�,�`-.�� = OTHER _ <br /> I HEREBV CEAITIFY'HAT I HAV$ EAD AND EXAMINFD THIS APPLICATION AND KNOW THE SAME TO BE TRUE "ID CORPECT. ALL <br /> PROVISIONS OF L1WS AND Oal-INACES GOVERNING THIS TYPE OF WORK WILL BE COA7PLIED WITH bYHE?HEN SPECIFIED HEFEIN OF <br /> NOT. THE GRANTING 0�1� 1.11T DOES N07 PRESUAtE TO GIVE AUTHORITY TO VIOLITE OR CANGEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LA'P/ U TING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCT�ON. THAT i AM AUTHOFIZED BV THE <br /> OWNER OF THISpRO �.iTY TO PEFF RM E WORK fOR WHICH APPLICATION IS A1ADE AND I COMPLY WITH THE ST4TE <br /> CONTRACT� 927 R N AND 96. 0 WAC. <br /> ) � ' i7 -UZ <br /> Signal� I Owner/C liactor/ or d AgeN Date <br /> ��Z <br />