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PE�iMIT APPI .ICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-9857 <br /> SITE ADDRESS PARCEL TAX I.O.# PERMIT a <br /> 100� Rrxke � �e�le�r Z��!o`� 1oSoo� �D7o�'-fXJ�� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. a S�� 2J�� <br /> OWNER AOORESS ZIP PHONE <br /> H��,��: p�o�-t,e� c���+. 3��aa ��,tb�,v�. � c �vERC�� �laZoS y2S-3�11-73bp <br /> TENANTNAME CONTACT4AME PHONE <br /> �,�c� ��� j�e\ Hc�c�ck t� z�- 2�io�zy Z9 <br /> CONTRACTOR ADDRESSr� V' �C VCRE�� CIp z0 C��iP�kQTUE2'p2 <br /> �-I�ar�k 3c�s , c�Ns�r, 3��aa ��� n c E 16 s <br /> PHONE <br /> �12�- 3�11-'�360 <br /> PROPOSED USE OF BUILDIIIG f"1 Buiiding n Mechanical Addilion HEAT SOURCE <br /> PERMIT fId� Combinalion F_� Plumbing WORK Alteration Q Electric <br /> C `-- �-. 7YPE �J Demolilion LJ Sign IYPE ' New QQ Gas <br /> �� � U Sprinkler Repair�MainL I U olner <br /> CONTRACT PRICE OF WORM. �s ()U Ca CITY OF EVERETT LOCAL SALES TAX COOE IS 31G5 <br /> WORK OESCRIPT�ON . • • <br /> N � w 5r R' - ,�u ZZi¢ . . <br /> � FLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF Fp(TURE OR ITEM <br /> I � WATERCLOSET A/C-A/HANDLINGUNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) _ HEAT PUMP <br /> � SHOWER UNIT HEATERS <br /> j / KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> . / DISHWASHER 1_ RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> I 1 CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> � UFiINAL FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> i _ BACKFLOW PREVENT'cR GAS PIPING <br /> SINK (SERVICE/8AR/IdOP/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> — � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF Li1WS AND OAIDINAC[S GUVERNING THIS TYPE OF WORK WILL 9E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERti11T OOES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OA LOC LAW REGI'LATING CONSTRUCTION OR THE�'ERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OW ER OF TH ROPERN TO PERFORM THE ORK FOA WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO CTORS WQ 7 CW 296200 <br /> � � '`5��2 <br /> i Sig Wreo ner/ConlractodA ho ' edAgent Date <br />