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P��RMIT APPLICATIt,N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �"' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDtiESS PARCEL TAX I.D.N PERMIT F <br /> �3d (��1� �N3q r �sCx�c'ac� i3oLo 3 -or <br /> LEGA LOT N0. BLO K TRACT <br /> oesc. ,S- (c `/'-��-p '� OF U��IL-I=� <br /> OWNER ADORESS LP PMONE ZS�J— 7 Z <br /> {�2#—Ct{�l S (-�4�Ziz'C.'R/LooK �o q �t�!4�dL. 19.�r.c� P2o l <br /> TENANTNAME CONTACTNAME / PHONE <br /> ' I / <br /> CONiRACTOR �YN�� ADDRESS ZIP CONTR.UCENSE N <br /> PMONE <br /> PROPOSEU USE OF BUILDING I Building Mechanical � Addi�ion HEAT SOURCE <br /> PERMIT �Combination R Plumbing IWORK B Alte�ation � Etectric <br /> GQ}{L(�(y{'*z 7YPE Demolition d Sign TYPE D New Gas <br /> Sprinkler U Repair/Meinl. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION <br /> cohtST�U�-C-�o� Glz- f� ZOXZ� � W�D �I�144t.(OC C��Gl`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPc OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> I = BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITC1iFN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATEFi <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> � _ DRINK�NG 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 /> � — <br /> i HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. AL'. <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVERN�NG THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> �.� N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br /> i OWNER OF THIS PROPEFN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPI.Y WITH THE STATE <br /> jC0���18.27�W D 296200 WAC. � / <br /> ' � li� � 3 L2 oL <br /> � SignaWre ol OwnedConlracror/Authonzetl Agent Date �\ <br /> i ` i�i <br />