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- P�RMIT APPLICATI(.�V <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.• PERMIT� <br /> AVe c�r .571 ]-00 6'tX�00 1 Co�q-.o� <br /> LEGA LOTNO. BLOCK ppQ TRACT 1 I <br /> DESC. q s OYc ACefS QGi�IT10✓� <br /> OWNEH ADDRESS aP PHONE <br /> Cr�w� 3�114 Wa� �lr 9�o�d'3 `/aSS/�/oY97 <br /> TENANT NAME CONTACT NAME PNONE <br /> S�a.r►1� S+eve CraW�oriQ <br /> CONTRACTOR 4 ADDRESS ��l LP CONTH.LICENSEI <br /> PMON�rAMI� �' Y �SSO� �YIH WGIK.. (XI 90�0.3 <br /> ydSSIN-oy47 ��erc ff �,J,�. CrawFA�rl�yCa <br /> PROPOSED USE OF BUILDING n Building � Mechanical Additiun HEAT SOURCE <br /> � � ^ PERMIT [� Combinelion Piumbing WORK R Alteralion I � Electr�c <br /> K, I TYPE D Demolitian Sign 7YPE � New Gas <br /> u Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK QO'�� //�G Q C? — CITY OF EVERETT LOCAL SALES TA%CO�E IS J105 <br /> o �/ <br /> WORK DESCRIPTION <br /> Revnor�el��dd��en <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OH REM NO. TYPE OF FlI(TURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> ,�_ SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL „� CIOTHES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> 1 LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER GA9 PIPING <br /> SINK(SERVICElBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I " <br /> � I HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> � PROVISIONS OF LA�VS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br /> NOT. THE GRANTING OF A PERMIT DGES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERIY TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT�W 1 7 RCW ND 29 200 WAC. <br /> SignaWre ol Owner/CoNract Authorized Agent Dale �/ <br /> /� <br /> I <br />