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P�:RMIT APPLICATI�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAA STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.+1 PERMiT w <br /> ��vo�3 �/ie�JCreS"I- {v�- Oo ���q ooa D/D D/ p <br /> IEGA LOT NO.s�(�p� BLOCK TRACT /� <br /> DESC. � E �QJ 6"F r- Jea.^V 1�Lc� ��/9/I fis <br /> OWNER ADDRESS LP MHONE <br /> 3'eA�,�-t�e, �a�'�� ���3 V���re,5fi fI✓�. �v�r��ff 9 B ao3 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTHACTOR � ADDRESS LPh CONTR.LICENSEI <br /> Cc��► L-c�'�e.n Co�s'}��,.�c'��on C�'g3a lY�� �nP� V1�rJ y� GfllZ�LGZIGcNfJ <br /> PHONE �n�''� <br /> /�a�h'- 3y9- /�/ (�"J��K� H'eo, GJfI� lSa73 <br /> PROPOSED USE OF BUILDING Buildin9 � MeChBniCal QQQ Addilion I HEAT SOURCE <br /> G�,��� C�-� 5 F PERMIT � COmbinnllOn PI9m6ing WORK � Alleralion (� Eiectric <br /> n 7YPE Demolilion Si n 1YPE New K Gas <br /> �e 5 !a'�YI GlJ Sprinkler RapairRdaim. LJ Olner <br /> CONTRACT PRICE OF WORK $ f�/�� B� J'1 7Gj � CITY OF EVERETT LOCAL SALES TAX CO�E IS 310i <br /> / <br /> WORK DESCRIPTION <br /> Gon �ert C�Por�f" i �t'o G—���5� <br /> PLUMBING MECFiANICAL <br /> I N0. TYPE OF FIXTURE OR REM N0. TYPE OF flXTURE OR ITEM <br /> I _ 'NATER CLOSET _ A/C-PJHANDLING UNITS <br /> EATHTUB FORCED AIR SYSTEMS <br /> l�1VATORY (WASH BASIN) HEAT PUMF <br /> SHOWER UNIT HEATERS <br /> , _ KITCHEN SINK 8 OISPOSAL CLOTHE5 DRYER <br /> � _ DISHWASHER RANGE HOOD <br /> , LAUNDRV TRAY WATER HEATER <br /> I _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> �� URINAL � FIREPI.ACE INSERT <br /> DRINKING FOUNTA.'� GAS FIREPLACE <br /> FLOOR DRAI� _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETG) EXHAUST FAN <br /> OTHER OTHER <br /> � I . <br /> I HtREd�'CEFITIFY THAT I HAVE READ AND cXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. ALl <br /> PROVISiOM1;.1F L1WS AND ORIDINACES GOVERNING THIS TVPE OP WORK WILI BE GOMPUED WITH�VHEfHEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORIN TO V�OLATE CR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUGTION. THAT I AM AUTHOR�2ED BY THE <br /> OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> GONTRACTOPS LAW 1 27 RCW AND 6200 WAC. <br /> �.�.2�� �=��/r� <br /> , Signa ure ol OwnedC riraclor/Aulhonzed Agenl Date <br />