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I PC .�MIT APPLICATIO. . <br /> CITY OF EVERETT PERMI7 SERVICE� I <br /> � 3200 CEDAR STREET, 6VERETT, WA 98201 �I <br /> � 425-257-8810 - FAX 425-257-8857 j; <br /> � <br /> l '� <br /> � � ���C.-/-� — � <br /> � <br /> SITE ADORESS PARCEL TAX I.D.a PearniT a ' <br /> G3Uo E�z 2�►c ►cw 28�yv.Zod3o �soo 2 -a3� � II <br /> � LEGA LOT NO. BLOCK TRACT � J� <br /> DESC. I <br /> OWNER AD�RESS ZIP PHONE I <br /> (r�AsN2nu.;oN ao�zNus boo U,�aucns7-ry sT. ��ZOsFa-,-,« 98ioi <br /> TENANT NA�r1E CONTACT NAME PHONE I <br /> S=G.NTE�H To�4n� DAcc.f� 2�3-yZ�-ZZ90 � <br /> nCONTRACTOR AO�RESS ZI CONTR.LICENSE M li <br /> /-H"r{ZxOT F=2E P�TEG7=or1 27°7 7oT� AvE E TACoriA WA 9�4Z4 <br /> PHONE /1�.v PA72zF�99 cF I <br /> ��'��l `�" i, <br /> � PFOPOSE�USE OF BUILDING Building � Mechanical Aadition HEAT SOUFiCE I <br /> I PERMIT Combinalion Plumbing WOP.K Alteration Q Electric � <br /> TYPE � Demolition Sign TYPE New �,j Gas � <br /> U FFu-� Sprinkler RepairiMa�rn. U Other I <br /> CONTRACT PRICE OF WORK � �,SQO.V p I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 i <br /> WORK DESCRIPTION li <br /> RDO 5��2�NKlfJ2 FI�OS �R /�Ew WALLS �•U� CF_xt_i�JC`S. <br /> , 42 1�'��� t'.�% <br /> I PLUMBING MECHANICAL <br /> �I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS ; <br /> LAVATORY (WASH BASIN) HEAT PUMP ' <br /> � SHOWER UNI1' HEA?ERS �I <br /> _ KITCHEM SINK 8 DISPOSAL CLOTHES DRYER �j � <br /> DISHWASHER AANGE HOOD I, <br /> LAUNDRY TRAY _ WATER HEATER r��� <br /> I _ CLOTHES WASHER _ METAL FIREPLACE/STOVE ��U+I I <br /> _ URINAL _ FIREPLACE INSERT l'�� � <br /> DRINKING FOUNTAIN _ GAS FIREPLACE / <br /> _ FLOOR DRAIN GAS RANGE ��, <br /> BACKFLOW PREVENTER GAS PIPING pl <br /> = SINK (SERVICE�BAR/MOP/ETC.) — EXHAUST FAN , I�' I <br /> OTHER OTHER � 6 I <br /> � � � <br /> I HEREBY CERITIFY'HAT I HAVE READ AND E?CAh11NE0 THIS APPLICATICN AND KNOVJ THE SAME TO BE TfiUE AND CORRECT. ALL I� <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COM17PUED WITH WHETHER SPECIFIED HEREIN OR '. <br /> ^lOT. 7HE GRANTING OF A PER1.11T DOES NOT PRESU6IE TO GIVE AUTHORIIY TO VIOLITE OR CANCEI THE PqCVISION OF ANY OTHER �I <br /> FTATE OR LOCAL U1W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE i <br /> !ER OF THIS°FOPERTY TO PERFORM THE'NORK FOF WHICH APPLICATION IS h1AL=AND I COAIPLY WITH THE STATE I <br /> TRACTOR�W 1627 RC�W AND 296200 WAC. � <br /> / / <br /> =� / «�-- . -iY -cs <br /> �ignalur of OsmerlGontractor/Authonzed Agent Date 1 <br /> ,-� lz �� <br />