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F� �RMIT APPLICATf�N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �'"' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857 <br /> SITE ADDRESSc,,'� I PARCEL TAX I.D.M �p�^,� PER T M <br /> 5�a� J�u�VIY.�.J �.1, `� � ���[JOGlJ �� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PHONE <br /> �k�l�r.h +- A�a,� Y�ue,��l I 512� Seu v;c� lact�., 9&.C� �5 �F?-�� <br /> TENANT NAME I CONTACT NAME PHONE <br /> �g}�GU �1.Gyl�� �7cf1-/7Z?t! <br /> CONTRACTOR /"� ADORESS ZIP CONTR.IICENSE N <br /> PHONE v(/`�'/��1../ <br /> PROPOSE�USE OF BUILDING I Building f'1 Mechanical I Adtlition HEAT SOURCE <br /> PERMIT R�.�[ CJmbination �_� Plumbing WORK R�.j Alleralion Electric <br /> TYPE �j Demolition �J Sign TYPE �J New � Gas <br /> � U Sprinkler U Fepair/Mainl. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORKDE�R�� ��✓, ^/GU�f.i G L/�eN`'V/ � SLttIFS <br /> I �.�J{ <br /> 4i2 s.F. <br /> PLUMBING MFCHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF Flx'fURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> � _ BATHTUB FORCED AIR SYSTEMS <br /> � _ LAVATORY (WASH BASIN) HEA7 PUMP <br /> SHOWER UNIT HEATERS <br /> _ KiTCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> � _ DISHWASHER _ RANGE HOOD <br /> � _ LAUNDRY TRAY WATER HEATER <br /> ' CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I URINAL FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � _ FLOOR DRAIN GAS RANGE <br /> I BACKF�OW PREVENTER GAS PIPING <br /> SINK (SERVICE�BAR/MOP/ETC.) EXHAUST FAN <br /> OTHEA OTHER <br /> I HEFEBV CEFITIFY'NA71 HAVE READ AND EXA1dINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPECT. ALL <br /> PROVISIONS OF L1145 AND ORIDINACES fOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHEfl SPEqFIED HEREIN OR <br /> ' NOT. THE GFANTWG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S'�TE 0(7 LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I PM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERIY TO PERFORM Ti1E WORK FOfi WHICN APPLICATION 1S NADE AND I COMPLY VJITH THE STATE <br /> CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> ��lM.�.ta- (` .I�t.IJ--� �l/t��0`> ^ , <br /> SignaWre o(Owner/�br�rac iAulhonzed Agenl Dale 1/i <br /> U <br />