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F�RMIT APPLI�ATILN <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.• � PE Mi7 t <br /> 0?,5/� l.Jr�/n-��� ,�.rv OQ'S!J/-5G-2 - 27-00 �0��. <br /> IEGA LOT N0. BLOCK TMCT � <br /> DESC. �'7 ��f <br /> OWNER ADDRE39 ��.,2_L�P PMO y; <br /> �� � . ��o��� ��, ,�� . � �� � � . �,,,,��e, c��- �� 5�s�� <br /> TENAN NAME ONTACT NAME—_� � P�F���/�,,,, Q <br /> � /� �`� <br /> !Y �'�- ��c.�,�_ /.t�D-u>,��.�,c/ �'�o GZ�! G_���- <br /> COtRRACTOR ADDRESS, LP CONTR.IICENSE/ <br /> PMONE <br /> .� - OG , � � �_ � t� IZl 2.. <br /> pROPOSED USE OF BUILDINfi I Building �MechBnical Addition HEAT SOURCE <br /> PERMR CombinaUon Plumbing WORN Alteratbn Q'�lectric <br /> TYPE Dernolllion Slgn 7YPE ew �J 6ee <br /> Sprinkler Repair/Meint. U Othar <br /> CONTRACT PRICE OF WORK CRV OF EVERETT LOCAL SAIES TA7(CODE IS�t0b <br /> WORK DESCRIPTION <br /> ,/;-�y,� n�., s��u�3so,r, _ � �-'„�L l}��� !,< <.c�� ,�!-�' <br /> �� ; <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM J `,��5 NO. TYPE OF Fl%TURE OR ITEM <br /> WATER CLOSET _ A!C—AlFiANDLING UNITS <br /> BATHTUB J FORCED Alq SYSTEMS <br /> _Q_, LAVATORY(WASH BASIN) HEAT PUMP <br /> OWER UNIT HEATERS <br /> � KI EN SINK 8 DISPOSAL LOTHES D R <br /> DISH SHER GE D <br /> LAUND TRAY � WA EATER <br /> � CLOTHES SHE ' ME IREPLACE/STOVE <br /> URINAL L F EPLA INSERT <br /> DRINKING AIN OAS FIREP E <br /> FLOOR AIN GAS RANGE <br /> � BAC LOW PREVEN R � C,AS PIPING <br /> � (SERVICElBAR/M ETC.) � EXHAUST FAN <br /> � <br /> OTHER _ OTHER <br /> I <br /> � � <br /> I <br /> ' I HEREBV CERITIFY THAT I HAVE READ AND F".OMINED THIS APPUCATION ANO KNOW THE SAME TO BE TRUE AND CORqECT. ALL <br /> IPROVISIONS OF fAWS AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETMER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. T11AT I AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPERIY TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITM THE STATE <br /> � COt�JIHACT S LAW RCW�p 296200 WAC. <br /> _ / �5��-� <br /> Sign�tur f Ow er ntfa o Aulhorized Agent ate � \ <br /> /eti <br /> � <br />