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P�r�MIT APPLICATICS�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITEADDRESS P '3 ����7o0X��COO Nt PE��I7MITN <br /> s .!' e / meOiOL � ✓�Z�`r-WI <br /> LE6A LOT NO. I� BLOCK TRACT , <br /> DESC. S O G CS �O Tr�+N fiVd�IET� <br /> OWNER �, ADDRESS aP PMONE 4ZS� <br /> �, f�cr� /�L ���v �i� irAne�«, �v��r�.r 34B-�z:z <br /> TENANTNAME CONTACTNAME pNONE <br /> NvN� �rc c 4 2�s—.¢z 2— 4 4 4 0 <br /> Li4R,Rtv Z/EAl�'L.� �Go-q,�tr 7930 <br /> CONTRACTOR�.,�E� ��VS'r�/�'�ppES ��� 2�,Z ,�j�p� CONTR.LICENSE� <br /> cKc 4�s-•¢z2 - 44`fo A5� c[ <br /> PMONE �_ r 3 �!R LIN6Tx��`Z13 ��� C �t��r b� <br /> d <br /> PROPOSED USE OF BUILDING I Buildfng I") Mechanical Addition XEAT SOURCE <br /> Rt�;r�v�L PERMIT Combination K Plumbing WORK B Allerelion Q Elettric <br /> ^� 7YPE Demolilion LJ Sign IYPE B New u pea <br /> Sprinkle� RepalqMeint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORKOESCR�PTONDEy��LJ��N .I/-� G�J�C�ST7�Y ,Q!/ /Ld//Y(e g�>,(J <br /> � �C-�ov� L �F B.�2 vs Ci` fa�•si0�9Tf-fl�'' <br /> .97Y t� T/{ EE 5 /i}r TfiC— Y� !'r�ri <br /> cm/�Z.��Oa/4 c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTURE OR(TEM <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 _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> ORINKING FOUNTAIN _ OAS FIREPUICE <br /> _ FLOOR DRAIN _ 6AS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND.CORRECT. ALl <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL 9E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PflOVISION OF ANY QTHEF <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONS7RUCTION. THAT I AM AUTHORIZED BY THE <br /> �•NER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ITRACTORS LAW 18.27 RCW AND 296.200 WAC. /� <br /> � /���y 9�4�o Z <br /> �r�t.-��-�- � <br /> ure of OwneVContractodAuthorized Agent te <br /> i <br />