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�— r <br /> • � � � PEr2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320C CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857 p � 'Z.y <br /> P/�-1 a- , <br /> SITE AODRESS '��'eRcN Co5 �t 1/I7 rttnAl .,..,��� r�v�n • �RMITN <br /> Legal Dexription: Sines J S Acro TraGs BIk ( G�— a� <br /> �7�� Sihl�/� 019D-01N1/BOfW12011 <br /> LEGA LOT NO. BLOCK OI BNc 19(ExBnpt P!f Sl <br /> oesc. a we Rep na4eo-oos� <br /> OWNER ADDRESS 37�I SIYIl��L. Z�P PMONE <br /> �t�.�,�� lf �� s � l Y11rsS� �*, �v, 9d�/ <br /> TENANT NAME CONTACT FOR PERMIT q 3u 3s�9 <br /> S�h`"c. I s�c� �l511�' ..[�jQ/��i� y�T'7�a'o - <br /> CONTRACTOR � p � 4.�,4 S �- ADDRESS �Z ��$ f�5/f �0 21P CONTR.LICENSE M <br /> PHONE ��C,�'Ii�f� 9�'�-3� <br /> ?��o `75�- G.�(3o <br /> PROPOSED USE OF BUILOING Building � Mechanical Additlon HEAT SOURCE <br /> J PERMIT � CPmbination Plumbing WORK R Alteration (� ElecMc <br /> �` TYPE Demolition Sign TYPE D New D Gas <br /> �CuS�H• %[��1��-/i`SS S rinkler D RepalrlMaint. D ome� <br /> LU.V i.✓A <br /> CONTRACT PR�CE OF WORK �'d ot��- CITY OF EVERETT LOGAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION /� /_ _�, - C��vi rl y I <br /> '/.�!`�7'7+r�:z'" I <br /> /v�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(VJASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEI 'EriS <br /> KITCHEN SINK 8 DISPOSAL CLOTH�S DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLOCE/STOVE <br /> URINAL FIREPL4CE IW ,ERT <br /> DRINKING FOUNTA�N GAS FIREPV+�'� <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENT�R GAS PIPING <br /> SINK(SERVICF/BAR/MOPlETC.) EXHAUST FAN <br /> OTHER OTHER <br /> - -- I - - — <br /> I HEREBY C.ERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRErT. ALL <br /> PROVISIO�S OF fAINS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE CJMPLIED WI'H WHETHER SPECIFIED HEREIN OR <br /> NOT. TH�GR.4NTING OF A PERMIT DOES NOT PRESIiME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISiON OF ANY OTHER <br /> STATE OR LOCAL IAVJ REGUTATING CO�JSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANC I COMPLY WITH THE STATE <br /> CONTRACTf�RS LAW 1827 W ANDr 296.200 WAC. <br /> ��c � ,,: e �.�G��� Z1'ev�cc.L G�' �� l+ — <br /> SignatuFn of 0 e C ntractorlAuthonzed Age�t Date <br /> DEBIT 8 CREQ'T CARDS ARE N07 ACCEPTED ,/Ot <br />