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--� <br /> PERMIT APPLICATIO�! <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.11 PERM�IT/M /` <br /> �Onl- �N�4��� Db S(�/ 5'D 1300/G 2 / / <br /> L[GA LO7N0. BLOCK TRACT <br /> DESC. PoC.f?�u1�� it 2. 13 f2vcxu�e P.a.e�c �Q� <br /> OWNER ADDRESS F ��� ZIP PHONE <br /> �DµN MOSTeOM �4 ��2n�N �Q,2pl 4Zs ZS2S70�j <br /> TENANTNAME I CONTACTIVAME PHONE <br /> Fo c��soti 42� soy 4�52 <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE 11 <br /> PAe�H�� C� q�GeS �N� 2�� �'u��c�� A�c- �L�'��B2v) <br /> PMONE <br /> ¢� � 2s9- i3 �� PAei�i oog�.v <br /> PROPOSED USE OF BUILDING I uilding f"1 Mechanical Addilion NE�T SOURCE <br /> PERMIT Combinalion �_� Plumbing WORK Aneretion [� Electric <br /> ����,� TYPE Dernolition i� Sign 1YPE ew �J Ges <br /> Sprinkler Repair/MainL L� Olher <br /> CONTRACT PRICE OF WORK 2 O/ O�U CITY OF EVERETT LOCAL SALES TAX COOE 19 3105 <br /> J <br /> WORK DESCRIPTION <br /> CONS7M-�!T NL'� �' ,Y� 4� F�/-1-E'AG� �L-���'1�-`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYP[OF FIXTURE OR ITEM <br /> ___ WAT[f�CLOSET /� NC-NHANDLING UNITS <br /> __ f3ATIiTU� FORCED AIR SYSTEMS � <br /> __ L�VAIORY (WASH OAS�N)�, _ HEAT PUMP j-`� <br /> SI10W[R % UNIT HE�7EHS <br /> KITG�iEN SIIJI<8 DISf'OSAL CLQTHLS DRYER /�' <br /> UISHWASHER � RANGE HO00 . <br /> LAUNDRY TRAY' WATEH NEATEi� �� <br /> CLOTIIES WASH[(i METAL FIREfSLACEBTOVE <br /> _ UfiINAL � FIREPLACE INS[HT <br /> DRINKIN y'�FOUNTAIN GAS F{I�[PU10E <br /> _ ROOR tSRAIN GA$'�iANGE <br /> t3ACKFLOW PRC-VL=NT6R G/(S PIPING <br /> __ SINK(S[RVICU[3AR/MOP/[TC.) _XHAUST FP.h" <br /> _ jI'fiER OTHER__ <br /> — `f_ <br /> � -- - <br /> I F1[H[UV CERITIFV 7�HAT I HAV[fiEAD ANL�EXAMWFD THIS APPLICAf10N AND KNOW THE SAME TO BE TRUB AND CORREGT. ALL <br /> PROVISIOIJS Of I ALNS AIJU GHIUINAC[S GOV[fiNIWG THIS TVPE OP WORK WII.L OE COMPUEU V/I1H WHETHER SP[CIFIEU HFREIN OR <br /> NOI. THE GRANTING OF A P[R�d1T DOLS NOT Pf7E5UME l0 GIV[�UTHOfi1N TO VIOLATE OR C4N'CEL THE PROVISION OF ANY OTHER <br /> S7ATG OR LOCAL LAW R[GULATING CONSTRUCTION OR THF.PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br /> OWNEIi OI°l HIS Pf7QPERiY QQQ70 PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACiOR 1y27��'29620QWAC. <br /> _�r �S`� ��l � ��� <br /> SignatLire ol Owned'- .Iractor/Authorized Agent Dale � <br /> Z <br />