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P�RMIT APPLICATI��V �;�' <br /> CITY OF EVERETT PERMIT SERVICES r e cord Qa <br /> 3200 CEDAR STREET, EVERETT, WA 98201 9 � i olo <br /> 425-257-8810- FAX 425-257-8857 �,� E,,��.�t 5 <br /> SP � ao �- o �s- 49 - � � zooza9io5oof - �o� aoqiooiza <br /> SITE ADDRESS � , PARCEL TAX I.O.N PER k <br /> �'��'S dgasos-ooi - 009 - o0 9--0/D <br /> LEGA LOT N0. BLOCK TRACT /� <br /> DESC. - •�_ � r ,S+ . 1 +D '�'�ie Tow'n OT '��d.�Q) ( , <br /> J <br /> OWNER ADORESS ZIP PHOYE <br /> Tr�e al c,�.�a y /�o�3 �o r N E ve�-ef f �1/4 yas� �o�- �'�DO <br /> TENANTNAME CONTACTNAME PHONE <br /> .._ _ l,� � I l�q-f <, j Y�d�a t/Zs-30�- �/DD <br /> /1 ( <br /> CONTRACTOR�, � � ADDRESS ` • '. ' , ; ZIP CONTR.UCENSE M�• . �� <br /> P0� 30I y TrtDwc iSIKI <br /> PHONE ��_ 3�3 - S�i6o ��reret-+ , Wa� 9��0� � �� � <br /> PROPOSED USE OF UILDING [�Building f'"1 Mechanical � � Addilion HEAT SOURCE <br /> s/Y7q�t �q rrl i I y PERMIT }�Combinelion �_� Plumbing WORK Alleration Electric <br /> J � TVPE D Deinolition L� Sign TYPE N <br /> i' e S � e n c cy U Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK F) � CIT`/OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �- �C�, Ill — <br /> WORK DESCRIPTION � • . <br /> ,g u � l�l �/.e, uJ S� 1-. ��n r� � ' . ': � . <br /> PLUMBING MECHANICAL <br /> NO. TYPF JF FIXTURE OR REM NO. TYPE OF FIXTURE OR.ITEM r <br /> � WATER CLOSET /�� A/C—A/HANDLING UNITS <br /> T BATHTUB ��� / FORCEDAIRSYSTEMS. <br /> �� LAVATORY(WASH BASIN) i�� HEAT PUMP . . <br /> SHOWER UNIT HEATERS <br /> _i KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> _L DISHWASHER � RANGE HOOD <br /> _ LAUNDRY TRAY Z WATER HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <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 /> I HEREBY CERITIFY THAT i HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF L.1WS AND ORIDINACES GOVERI�ING THIS TYPE OF WORK WILL BE COM1IPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORI�iV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTNER <br /> S7ATE OR LOCAI LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B1'THE <br /> I OWNER OF THIS PROPERTY TO PEAFOqM THE WOPK FOR WHICH APPLICAT�ON IS MADE AND�COA7PL'(WITH THE STATE <br /> � CONTR CTORS LAW 1827 RCW AND 296.200 WAC. <br /> Sign wre ol O r/CoNractoU�W t / �e `� �L <br />