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� <br /> PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �-" 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-88P7 <br /> QGIII -o <br /> SITE ADDRESS � PAHCEL TAX I.D.N P iT• <br /> 3/// TGfC �C/� �G- DOSS' -7d7-006 -DD I�"li� <br /> LEGA LOTNO. dLOCK TRACT <br /> oesc. ( S 7.2 ��J�".n ,�.�.-.�v � <br /> OWNER AODRESS LP PHONE <br /> ?///- TN[ AC/� q�zU/ <br /> o�J�, � ���«F ��� , 6`,zs=ZSS'- �73s <br /> NANTNAME � CONTACTNAME PHONE <br /> CONTRACTOR` ADOHESS <br /> �.S(l�,J� �O�'7t ��,�6 �„� ZIP CONIA.UCENSEM <br /> VHONE / gfr 3 � �S"_6 h?d� �E- .��o,�i�J rl, r � �_ f ?3� <br /> _ /�25= ��z- � 7� � �' €'d7Z � ��°G�� � <br /> PROPOSED USE OF BUILDING I Building Mechanical Addilbn HtAT SOURCE <br /> PERMIT B Combination R Plumbing IWORK�AIIera�ion I (7 Electnc <br /> TYPE D Demolilion � Sign TYPE New Gas <br /> U Sprinkler Repair/Mainl. B 01her <br /> CONTRACT PRICE OF WORK ? � CITY OF EVEAETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � �K �9, <br /> �e M uV t %�t�C'i� - ��� /�L X � '. <br /> 9�e'3'[�«r ��� ^ C'v[/G=rc �'cn)C+�t /�X� .�vE-S �or�'cn/o=rC A�c <br /> `� �cZ.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FII(TURE OR ITEM <br /> _ WATERCLOSET _ q/C-A/HANDLINGUNiTS <br /> _ F3ATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> __ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ �ISHWASHER RAN,EHOOD <br /> _ LAUNDRYTRAY _ WATER HEATER <br /> _ CLOTHES WASIIER MET�L 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 HEREgY CERITIFY THdT I HAVF READ ANO EXAh1WED THIS APPLICATION AND HNOW TNE SAME 10 BE TRUE AND CORRECT. ALL <br /> PROViSONS OF Li1NJS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> N07�. THE GRANTING OF A PERMIT DOES NOT PRESUM1IE TO GIVE AUTHOPI fV TO VIOLATE OR CANCEL TNE PROViSION OF ANV OTHEH <br /> STATE OR LOCAL LAW REGUTATING CON ItCTIO�J OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO OV THE <br /> (�WNER OF T I$PROPERTY TO PERF THE WORK FOR WHICM APPLICATION I MADF AND I COMPLV WITH THE STATE <br /> CONTR RS LAW 1827 RCW 96 WA <br /> I ✓'-i ,/ �h� �� ��/U/ <br /> � vI S n e OwnedContre to uthonzed Agent a1e �/a <br /> � I <br />