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P�RMIT APPLICATIOrI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.N PER IT M <br /> �� � I IN� a le S i. 00- 430 -z2�- os- oo — <br /> LEGAL LOT NO. BLOCK TRACT , (/� <br /> DESC. J g o� �.�' `Tl� Z. (�� <br /> OWNER ADDRESS PHONE <br /> k 5 L ' C�c.�lJ u t�l ct (e ,- v ��-- 4z s)33 -'q 6 �a <br /> TENANT NAME CONTACT NA E PHONE <br /> Ji m C� ui nl �1 4Zs`) ��a- �s'��s— <br /> CONTRACTOR pDDRESS CONTR.LICENSEN <br /> '"r'ow � 5 C�un��l-a-y . I� szi NwY �`� 5�- '� '7t,wN �PFoqALT— <br /> PHONE�S �43 - ISSs � UWOOc� � � �80��-. <br /> PROPOSED USE OF BUILDING Buildiig Mechanical Addition HEAT SOURCE <br /> ►>e�-Ac4�ed 9nrz � PERMIT Combination � Plumbfng WORK AltereOon "� � Q Electnc <br /> � TYPE Demolit(on Sign TYPE � New N/iY-�J Ges <br /> Sprinkle� pepair/Maint. U Other <br /> CONTRACT PRICE OF WORK � 5 �� 1 �3 . � CITY OF EVERETT LOCAL SAIES TA%CODE IS 3705 <br /> WORK DESCRIPTION e� � S�,L1 C r 0 N e � a S I �i`A►Vl e d e�t-c,� (� e c( <br /> �I-90 c� � a�z0.ye . <br /> L MBINO MECHANICAL <br /> NO. TYPE OF FlJ(TURE OR ITEM TYpE OF fll(TURE OR ITEM <br /> WA CLOSET —A/HANDLING UNITS <br /> BATHT _ FOR D AIR SYSTEMS <br /> LAVATOR ASH BASIN) _ HEAT P P <br /> SHOWER _ UNIT HEA S � <br /> KITCH[N SINK& SPOSAL _ CLOTHES DR R <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHEF _ METAL FIREPLAC VE <br /> URINAL � FIREPLACE INS T <br /> DRINKING FOU iN _ GAS FIREP <br /> FLOOR DRAI _ GA8 RAN <br /> � BACKFLO REVENTER _ GAS PI G <br /> SINK( VICE/BAR/MOP/ETC.) _ EXH ST FAN <br /> OT _ O ER <br /> I HEREBY CERITIF�THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE.QND CORRECT. ALL <br /> PROVISIONS OF LA:YS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COIv1PL1ED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES 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 BY THE <br /> OWNER OF THIS PROPERTY TO P RFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT LAW 78.27 RCW A D 296200 WAC. <br /> �� Q �8 �� l <br /> Signalure a wne/Contrac AUthorized Agen Date � , � <br /> � �(.h� <br /> } <br /> '� <br />