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P,�RMIT APPLICATI 'l.N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, cVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESSn PARCEL TAX I.D.M � PnERMI7 u / <br /> G.L�J� ///�IL�ILL �Ks-�k ��Q.Y.L�?7y � � �yU�. U� � 0 1/Ol/V'1 vQl <br /> LEGA LOiNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS LP PHONE <br /> C'i�,v�vA2. L�� 93ts9 C/yno�c l�ew De�avu F�mo.vD3 WR 98oZ� <br /> TENANTNAME CONTACTNAME y PHONE <br /> _ I N�A�� t.c��� ur 1�re Ssy�8� p <br /> CONTRACTOR Ta. a• ADDRESS ZIP CONTR.UCENSEN <br /> PHONE <br /> PROPOSED USE OF BUILDING I Building Mechanical Addition HEAT SOURCE <br /> /� 1 I PERMIT Combination R Plumbing WORK R Alleralion � Electric <br /> �LO �� �_ TYPE Demolition � Sign 7YPE ❑ New �J/� Gas <br /> �� �� Sprinkler U Repair/MainL Othar <br /> CONTRACT PqICE OF WORK ,(-�1, �'� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> ��V <br /> WORKDESCRIPTION ��YLAtG MCt7��C07h'S� Cp,Vµ,NO �cPv�Pm£NT � A��NN}�5 �:TN <br /> C1Nt�uLAR� E�u�PMEN? � AN'f�AINAS. MJ�lUPO(-� d EG1UlPME,JT �OM�OJ.tJO /5 <br /> f1612EA0y PE�/r117'T�P TNe6 (Jc�N MET�lCa7�n�5Pla�� ✓UiCdSTRcA/"L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM NO. TYPE OF flXTUflE OR REM <br /> _ WATER CLOSET _ PJC-A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL _, FIREPLACE�NSERT <br />/ _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER <br /> � ' <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TFUE AND CORFECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE CCMPI!ED WITH WHETHER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING OF A PEfiMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL}d2W REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br /> ; OWNER OF THI$�RbPERTY TO PERFORM THE WOR!<FOR WHICH APPLIC.4TION IS MADE AND i COMPLY WITH THE STATE <br /> i CONTRACT R�L4W 1827 RCW AND 296. 00 AC. <br /> `�' i <br /> ���� <br /> ig r2' wnedConlractoU h zed Agenl Date <br /> � <br />