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' �� �_ ERMIT APPLICAT JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> �a oo� o��/ oa�l� CG`� a �� ' � <br /> SITE ADDRESS I�� pApCEL TAX I.D.�I PERMIT x <br /> /a � J� SE Si��k' 12UL -LL- c� i Ai_�ala-Or• `� <br /> LEGA LOTNO, BLOCK TRACT <br /> oesa 2 <br /> pyy,dEp. AOCRESS ZIP PHONE �L� ZS� <br /> `\ /��(-� ,�(/'_'- / � ���� . <br /> ( )'Ll'T l�lJ��`l ��3 �. �A�, CS � UU� IIC� IbG. S�CJC.J1 V.�ic.� <br /> �NANTNAME I CONTACTNAME PHONE <br /> G.C-G��', �-lC>>.�.es 1,�� . ��„�NZ S ���F <br /> CONTFtACTOR ADORESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSEO USE OF BUILDING Rt Building f"1 MBChaniC81 I Adtlilion MEAT SOURCE <br /> PERMIT K{.-1 Combination K Plumbing WORK Alleralion kn-[ Electric <br /> TYPE �j Demolition LJ Sign TYPE Naw �] Gas <br /> S.r-.t� �� Sprink�er Repa�riMaint. U Otner � <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORKDESCRIPTION ��,`G` A . I� 3 V � J ��Z .• • ' <br /> PLUMBING MECHANICAL <br /> i <br /> NO. TVPE OF FUCTURE OR ITEM N0. TYPE OF FlXTURE OR REM I <br /> i WATERCIOSET A/C-A/FiANDLINGUNITS <br /> /�- BATHTUB � FORCED AIR SYSTEMS , <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP � <br /> SHOWER UNIT HEATERS <br /> i � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> I I DISHWASHER l RANGE HOOD <br /> j � LAUNDRY TRAY 1 WATER HEATER <br /> CLOTHES WASHER � METAL FIREPLACElSTOVE <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 HEF7E�Y CERITIFY 7HAT I HAVE READ AN�E%AP�IINED THIS APPLICATION AND KNOW TI1E SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS NPE 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 PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW�aEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEF trPEWfOFM THE WORK F R WHICH APPLICAT�ON IS MADE AND I COMP�Y W�TH THE STATE <br /> �. CONTRACTORS WW 1 RCW AND 96.200 WAC. <br /> � rt y�o= <br /> Signawre wnenConlracto Authonzed Agent Date <br /> 5C= oc` <br />