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JUL-28-c006 a7:25 FR011:PEiit9IT 42�7756315 TG: 142_`•c578857 P.c <br /> �-- PERiVIIT AF'PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FFJC 425-257-8857 7` ���� <br /> SITE A�DRESS q � PARCEL TAX I.�. # PERt.4i7 tt <br /> 2�r�Z V � ��i' 1 DOSs3/ao�� /od �1'� 1 � : ? - �� � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC.__ _ <br /> OWNER � ADDRESS !� u�� ZIP PHONE <br /> C�I,�J�V1 h ) Uf'{i C_e_. �-�Z 1�lCfu,- � � L -�1,�?�i / �Z�Z� '�-�S <br /> TENANT NAME CONTACT FOR PERM1IIT PHONE <br /> �!'c� �u-c. � ,(���d� yzs 2��- 8-w�? <br /> CO�AnCTO� `,r��� (�n �!��! r A�DRESS Z�P CONTR.LICENSE# <br /> rl�/ Z � ���'Y, k�2 ,�,� � Gt�/P-J�fr/�.1%7/Q3 <br /> PH02�(Q ZS_� [17�z� �n,� '�` 4�'�A 9 <br /> PROPOS[D USE OF oUILD�NG BuilJiny �j Alechanlcal Addition HEAT SOURCE <br /> � PERh71T � Combinalion H Qlumbinc� WORK �Aticraticn Electric <br /> � NPE Dem0lilion LJ Sign TYPE New �Gas <br /> L� S;!rinkler RepaldMalnL Other <br /> CJNTRACT PRICE OF WORK eo �� — CITY OF EVERE7T LOCAI SALES TAX COOE IS 9105 <br /> WORK DESCRIPTION � �� �� �n n� �/ V <br /> . �� l�C�e�/f'�Qfll <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTUR[OR ITEh1 NO. TYPE OF FIXTURE OR ITEh1 <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHiUB FORCED AIR SYS7EM115 <br /> LAVATOf2Y(WASH BASIN) HEAT F'U�1P <br /> SHOWER UNIT HEATERS <br /> i KITCHEN SINK& UISPOSAL CLOI�HES DRYER <br /> DISHWl+.SHER RANGE HOOD <br /> LAUNDRYTRAY Z WATERHEATER <br /> CLOTHES WASHER METAL Flft[PLACt/S I UVL= <br /> URINAL FIREPLACE INSERT <br /> DRIIJKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS HANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> ' SINK(SERVICE/BAP/MOPIETC.) EXH.4UST FAN <br /> OTHER OTNER <br /> i — <br /> I HEREBY CEftITIFY THAT I HAVE REAU l�NO EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISICNS OF LAWS AN�CRIDINACES GOVERNING THIS TYPE OF WORK 1NILL 6E COMPUED V.'ITH 1NHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN7ING OF A PERh11T DO�S NOT PRESUAIE TO GIVE AUTHORIN TO VIOLATE OR ChIJCEI THE PROVISION OF ANY OTHER <br /> STATE OR�OCAL LAN REGULATING CONSTRUCTION OR THE PERFORAI�NCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED 0V THE <br /> OWNER OF THIS PROPER7Y TO PERFORAI THE WORK FOR WHIGH APPLICATION IS h1FDE AND I CC!dPLY�VITH THE STATE <br /> CONT CTORS LA` , 27 RC1N AND.96.20°�`� 7� <br /> G1cc��. YYi S-u� CJ ?�.f0 CP <br /> Si at re of OwnenCon«actoNA rized Ageni Date <br /> DEBIT 8 CREDIT CARDS ARE P:OT ACCEPTED <br />