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1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT,WA 38201 <br /> 425-257-8870—FAX 425-257-8857 <br /> Qr� 3oa - D� G� <br /> SITE ADDRESS PARCEL 7AX I.D.8 PERMI7 q <br /> 'zc7 � �'o�� 39a� o�o o.� v�oa L '� -o�/ <br /> LEG.4L lOT O. BLOCK TRAC7 <br /> oesc. '1Y—ttt 1�1 fn 4 y Rc�'E�}G E 7'QN�F� <br /> OWNER ADDRES3 211'' PHONE <br /> l�t��,n� NaM� u.� f?o. �ox, i'�N7 �u�u, c�.L�kr (�u�_9�oBz__ zc�-v9�- � <br /> TENANTNAME I CONT .CiNAME <br /> /y PHONE <br /> —_�1� A� �lv� <br /> CONTRACTOR ADURESS ZIP CONTR.LICENSEA <br /> PHONEn,�,I- � �-7�A�(�'^ <br /> L.11l7`�q � W Iv <br /> PROPOSED USE OF BUILOING I (�,Bullding Mechenital Addhbn HEAT SOURCE <br /> PERMIT �JCombin0tion � PlUmbing WORK � Altoration I �Electric <br /> iVPE D Demolition Sign 7YPE Now Ges <br /> U Sprinkler RopalrlMeint. pyK� <br /> CON7RACT PRICE OF WORK CITY OF EVERETT LOCAL 9ALES TAl(CODE IS 7105 <br /> WORK DESCRIPTION <br /> CbNs�v�T ��w i��t� S.F- M��,-�-r2y, S/�'4c� -F�rr���y •,2.�s�b � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%Tl1ftE OR ITEM <br /> WATER CLOSET A/C-AMANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORV(WqSH BASIN) HEAT PUMP <br /> � SHOWER UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRYTRAY WATER HEATER <br /> T CLOTHES WASHER METALFIREPLACE/STOVE <br /> ,B URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN Z GAS FIREPLqCE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICElBAR/MOP/ETC.) EXHAUST FAN <br /> �THER__ OTHER <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KN01'!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 OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR 7HE PERfORMANCE OF CONSTRUCTION. THqT I AM AUTMORIZED BY THE <br /> OWNER OF IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLi� N IS MADE AND I COMPLY WlTti THE STATE <br /> CONTRA 5 LAW 18.27 R W AND 29G.200 WAC. <br /> _.� �� z��9/�3 <br /> Signalure of wnerlContraclortAulhodzed Agent Date ,�` <br /> 1'Z <br />