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f��RMIT APPLICATI�,N <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�.D.M PEiiM1T M <br /> Z1/ �- L� XD <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWN ADDRES�O`b �,, i1�� ZIP PHONE <br /> Q nfy.� <br /> � r ���c ��c- ,�uu� ��o'L'y S -57 <br /> TENANTN E CONT CTNAME PHONE <br /> �vrH 'P'-/roK.t�� �a� 7s� �/�:— <br /> CONTqACTOR �j '1� 'r ��,(/1YJ/3/Y1 L� ADDRESS ms"� /�3 � /(�Ip CONTR. LICENSEM <br /> .� / � v�^'T/x,L 0//f <br /> PNONE�l�o�S �� ��Y�- �ys�,�� �.�- ���� <br /> PROPOSED USE OF BUILDING I""1 Buildi�g Mechanical Addition NEAT SOURCE <br /> PERMIT 4_� Cpmbination �Plumbing WOP.K � AltPratioo � Elearic <br /> S �"'� TYPE �..j Demolition Sign 7YPE New Gas <br /> U S rinkler Re ainMaint. Other <br /> CONTRACT PRICE OF WORK l `= CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> (� <br /> WORK DESCRIPTION � <br /> t�/c•�srh �,v �/ic c s� �os�'c/ vcso�5� Gcr.o <br /> w`� �. /�%�c , ,�i�ioy a,t�0 ,h-s�l� h<<,.� -,C�,,e��Kcs <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM N0. TVPE OF FIXTURE OR�TEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> .Z BATHTUB _ FORCED AIR SY3TEMS <br /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> � � SHOWER UNIT HEATERS <br /> I � KITCHEN SINK 8 DISPOSAL _ CLQTHES DRYER <br /> i � �ISHWASHER = RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> ..,L CLOTHES WASHER tv1ETAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKINU' FOUNTAIN GAS FIREPI.ACE <br /> I _ FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> j � fi'C,U T <br /> I — — — — <br /> ' I HEfiEBY CERITIF•Y'HAT I HAVE AEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TqUE AND COPR!'CT. AlL <br /> � PROVISIONS OF WWS AND OflIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIL'D"cREIN OR <br /> NOT 7HE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVtSION O!�ANY OTHER <br /> STATE OR LOCA�LAW REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOPIZED BY THE <br /> OWNER OF TH S PROPERTY TO PEPFORM THE WORK FOF N'HICH PPPL�CATION IS MADE AND I COMPLY WITH THE STATE <br /> i CONTRACT S LAW 1827 W AND 296.200 WAC. <br /> � ..�Ct4 //!� �'P.S "d 2 <br /> . S� alure of Owner/ onlraGor/Aulhorized Agent Date <br />