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I <br /> i PERMIT APPLfCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FNX 425-257-8857 <br /> �Z � �f`�5 <br /> SITE AD�RESS , PARCEL TAX I.D.# PEP.6�17 n <br /> –7..� ., �� L`�p��'i,.' /u�r' /1:?� r � � � -- <br /> LEGA � 1 LOTNO. BLOCK TRACT <br /> DESC. <br /> <IP PHONE <br /> ADORFSS _ <br /> OWNER y6� <br /> Sy/ 35d <br /> ��nle �Se� ► ler iaos wNln� Si 7�heDu//es Cr�i��3� �rTc)s�- � <br /> TENANTNAME CONTACTNAME PHONE I <br /> �i a 313 �lSo� I <br /> � <br /> CONTRACTOR��s�(,UQ✓,4 ��u'�r�, ADDRESS ZIP CONTR.LICENSc# <br /> 2yl�° '� �' `�'" E Gmow ,xle��-+li�I <br /> PHONE ^�' � cf�2�3 �' <br /> ^Ji" 1f�1'�/ � I <br /> PROPOSED USE OF BUILDING Ouilding I� Mechanical Atldition HEAT SOURCE i <br /> PERMIT R Combinalion 4_� Plumbing WOpK ��ItcraLon n Electnc I <br /> TYPE D Demolition L.7 Sign 7YPE Nc�v H Gas I <br /> U Sprinkler(k ol heatls) RepairRdoint L� Other I <br /> CONTRACT PRICE OF WORK 'JJ ��p ��- CITV OF EVER[TT LOCAL SALES TA%CODE IS 3105 , <br /> WORK�ESCRIPTION �Uy� V�v a- ;"r tAr� Q �r'��. .s�.� rfC`d — •�'L.,�Li-1 � tY ti�t�f v���t��4' i <br /> i <br /> PLUMBING MECh�ANICAL <br /> IJO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C–AJHANDLING UNITS <br /> BATHTUB _�_ FORCED AIR SYSTEA45 i <br /> LAVATORY(WA�H BASIN) _ HEAT I'UMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHV�ASHER RANGE HOOD <br /> LAUNDRY TRAY —1_ WATER FiEATER <br /> CLOTHES WASHER METAL FIREPLACE'STOVE <br /> URINAL FIREPLACEINSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN 1 GAS RANGE i <br /> BACKFLOW PREVEN?ER GAS PIPING � <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> � OTNER OTHER _ _ <br /> — — — — j <br /> I �' <br /> i, I HER[BY CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPUCATION AND KNOW THE SAI.1E TO BE TRUE AND CORRECT. ALl <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COIdPLIED WITH WHEfHER SPECIFIED HEREIN OF <br /> � NOL THE GRANTING OF A PERMIT DOES NOT PR[SUA1E TO GNE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br /> STATE OR LOC�L LAW REGULATING CONSTRUCTION OR THE FERFORh1ANCE OF COtJSTRUCTION. THAT I A67 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS�dADE AtJD I COIdPLY 1'JITH THE STATE I <br /> CONTRACTORS LAW 1B27 RCW AND 296200 VJAC. <br /> I Si!�nature ot Owner/CoNractodAuthonzed Agent Dale <br />