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PE� �MI"�' APPLICATIO�i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-9810- FAX 425-257-8857 <br /> ��J�� 7 "O/ <br /> SI7/E ADDRESS ( PARCEL TAJ(I.D.!t PE^R'Mrt^M <br /> �Ol v J�: 4�..i..r a-f �IJL � y3 J ^('C7U 'C73C7 'UZ �4� / � � <br /> LEGA LOT�JO. BLOCK TkAC� <br /> DESC. I g j� <br /> OWNER ADDRESS ZIP PHONE (� )j��� � <br /> � }-L Jrne S tn��. S � 3 l'.- �.JAJ� e � 1�� �2�1 � 13H �A <br /> L(a�l: <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ADDHESS ZIP CONTR.IICENSE 11 <br /> PMONE y L � Z 4 C u },_�,,� <br /> PROPOSEU USE OF BUILDING Building f� MeChenical Addilion MEA7 SOURCE <br /> � }.�� ,y S F� , I PERMIT �omtina�ion i_� Plumbing WORK R Alteralion I �Electric <br /> IYPE Demolition U Sign IYPE D New Gea <br /> Sprinkler U Repair/MeinL Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTJON <br /> 3�.�1�� A' n� ci..� 1'7 z;, � . , • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl7CTURE OR REM NO. TYPE OF Fl%TURE OR ITEM � <br /> WATER CLOSET A/C—AlHANDLING UNITS <br /> Z BATHTUB � FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> l KITCHEN SINK&OISPOSAL 1 CLOTHES ORYER <br /> 1 DISHWASHER = RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> ___�_ CLOTHES WASHER METAI FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> I _ FLOOR DRAIN GAS RANGE <br /> , _ BACKFLOW PREVENTER .'� GAS PIPING <br /> SINK(SERVICEiBAR/MOP/ETC.) �: EXHAUST FAN <br /> OTHEA OTHER <br /> i <br /> I <br /> 'i I HEiiEBY CEFITIFY THAT I HAVE READ AND E%AMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORREGT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIE�WITH WHEfF1ER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL TH�=PROVISION OF ANY OTHER <br /> �i STATE OR IOCAL lAW REGUUITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 aM AUTHORI2ED BY THE <br /> � OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WNICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> j CONTRACTORS LA . 7 RC ANO 296 00 WAC. <br /> I '� 76 �i . <br /> Signalure ol Own Co actor/A n ent ate <br /> � � �/z <br />