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P�IiMIT APPLICATII,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> 2Sd .?_ (�.��/e''' �v,-,�r� _ <br /> S`�T.�ADDRESS t�V(J'��_ %,�`W�� ��P$ACEL TAX I.D.i PERMIT� <br /> �,�[ �c`�r`I�-VJETMc'1z�� _ BO�oto-ol <br /> LEGA LOT NO. LOCK TRACT <br /> DESC. <br /> OWNER ADDRESS aP P ONE <br /> �t��'m�.� � � 7�/ l,velma �5� �'� 9�2oJ <br /> 7ENANT NAME CO ACT NAME �}-� PH`ONE � —J <br /> �--i"ti(��t-r/'[�( ���`FI ����-1 �� �`/X�lt�'F-F I `��'7� <br /> ��» I � <br /> CONTpACTOR ILttr�C`� ��I��R€S�8 ��Tr- IIP CONTH. ENSL_TC EN <br /> 1 l I t.T�� <br /> PHONE �IL � l� I � ( � C {, „�. � � .!� <br /> T�� <br /> PROPOSED USE OF BUILDING Bu' ing I"1 Mechanical � n 4ddi�ion NEAT SOURCE <br /> }���/�(�-, �,�y.�� �- PEPMIT Combination �Q Plum6ing WORK F�a1( Alteralion Electr <br /> �y.,Vj��,}�) ��J� TYPE oemouuon �� S(gn IYPE u New � Gas�� \� <br /> t � � �� Spdnkter U Repeir/Maint. Other � <br /> NTRACT PRICE OF WORK � � � ' �J CITV OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORK DESCRIPTION <br /> • {�Ikk`-t� ���� c� � —�fj�fil�-�%. 1N�L�"�'-`N �L-=!tl�.!" �� - T/S�SA'fi�t{ <br /> .t�T� � `.�.�f�I�'l N �i�1`.E-=�'!}C'-f� - --jl�7'�.�51 t� _ � -rC •;dC?�CC�ht � <br /> C <br /> •C� 2`(U1c� �v J�CfF� d. `'� r �(� � . , <br /> PLUMBI MECHANICAL <br /> NO. TVPE OF FlXTURE OR REM NO. TYPE OF flXTURE OR ITEM <br /> WATER CLOSET A/C—AIHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER . ,I� UNIT HEATERS <br /> Ej�3 K TCH�EN SINK��,�f�,(�LL1 _ CLOTHES DRYER <br /> DISHWASHER �l RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHcS WASHER METALFIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> _ DF�NKING FOUNTAIN � _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> i _ SINK(SERVICE/BAq/MOP/ETC.) _ EXHAUST FAN <br /> _ 'vTHER OTHEH <br /> i — — <br /> I HEREBY CEFITIFY'HAT I NAVE READ ANO EXAMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF tAWS AND ORIDINACES GOVERNING THIS TYPE 9F WCRK WILL 8E COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR Ld- aL lAW REGUWTING CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> O NER OF �� •�PROPERTY TO PEPFORId THE W4RK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CO TRACT�`.i.�. .4�8�27 RCW AND 296?.00 WAC. � <br /> , o ,o ��� p:� <br /> o � <br /> . �� <br /> Signatur .' wn rl ontractor/Authon aC A eN ate <br /> �%I j <br /> ! <br />