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F RMIT APPLICATION <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 I.D.M I CoPERMIT 0 <br /> �^ <br /> /J/S-G 13A /rE( - EI,ERe7r 4.4 _?(?4-0G <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 6' — 6cuit* I/E L v/ CO//j/"/?-uE 13:1JW.;rr 4//1 7S.7u/ /"teas- -590 <br /> TENANT NAMEI CONTACT NAME PHONE <br /> CONTRACTORC4 e;yA- 1 CAR /'f_ 1 ADDRESS ,y/ . AA if E w a„P ebZIP CONTR.UCENSE 0 <br /> Ci:.moiivi n7 L py,t S74,vwoo0iwA 98.492 C''4,'frc-c- ef7 /cC <br /> PHONE ,3 o 6 s''j/ /y 53 <br /> PROPOSED USE OF BUILDING uilding R.Ii‘intiAechanical Addition HEAT SOURCE <br /> PERMIT Combinallonmbing WORK Alteration 3tectric <br /> TYPE Demolition Sign TYPE New Gas <br /> Sprinkler(0 of heeds) Repatr/Matnt. Other <br /> CONTRACT PRICE OF WORK /16010 •CITY OF EVERETT LOCAL SALES TAX CODE 1S 3106 <br /> WORK DESCRIPTION re"M r,t.• A . R,- /A ' - CA OrC 7`/t'u e A- it, I Sox,4 574.4 Ss <br /> PE", '0,J F A if A:- l7/9 ' L- 744 SAt.w,4./t L milt-- <br /> \i.,1-At Ci � Ay ath ) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ATER CLOSET(TOILET) NC—NHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> './LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAINGAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) 7 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 LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER 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.O THIS PROP RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAfC,XINIS LAW .27 RCW AND 296.200 WAC. <br /> . 4-7 4f/1,`--- c►� oJ � <br /> Signatu o Ownerrt.ut�tractor/Authorized gent Date '� <br /> �) <br /> r <br />