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PFRMIT APPLICATIC`N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �"`" 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-�57-8810 — FAX 425•257-8857 <br /> SITE ADDRESS J PARCEL TAX I.D. # PER���T <br /> i <br /> ��i•,I -'�'�IS ��-r-i1 N-v� C��Fxz;Z�Cr%1 k �D�" ooL <br /> LEGA LOT NQ. BLOCK TRACT <br /> DESC. <br /> OWp ER ADORESS ZIP PHONE <br /> 1+��� �-eccr 1��E��r-rcu;� �n� -�S �-+��n1�F R�CI dzs-Zs�f-4d� <br /> T�NANT NA�dE �lTACT NAIdE 1 PHONE <br /> FCJEZL !"I�Uj�cTL��Iti.Y-� K�IEe (ENti-�k� '11S����'�S� XZl <br /> CqN�TRA� CTOR ADDRE ZIP COr TR.yCENSE M <br /> l�vr�cev �irzE �or�crrc� I`�7�, !'�4 "� �t II..L `��o7z kA✓h+-�F�i ,Kr�hl <br /> PHONE C(,,���+ti�(LL� WA <br /> '�2S� -��- -,.��`� <br /> PpOPOSED USE OF BUILDING I f7 Building Mechanical ,L-✓,I/Addnion HEA7 SOURCE � <br /> MG�L- PEPMIT �� Combinalion � Plumbing WORK I ) Alleration I n Electric � <br /> TYPE �.j�Demolitian Sig❑ TYPE � New g Gas <br /> M����;�.�,p„�;� L�l Sprinkler Rr.pairRdaint Other II <br /> CONTRACT PRICE OF WORK �,ZZ 7 CITV OF EVEREff IOCAL SALES TAX GODE IS 3105 � <br /> �c3s ' <br /> WORK DESCRIP�ON � <br /> .�hJ`-�ifiYL ��1�'IF--Y�lLE7'�� ll..' IJL_l� �IT7c� �l�.3 I�� � <br /> PLUM8ING MECHANICAL i <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER GLOSET _ A/C-!v'HANDLING UNITS '�, <br /> �ATHTUB _ FORCED AIR SYSTEMS � <br /> LAVA7GRY(VJASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER I <br /> DISHWASHEF _ RANGE HOOD � <br /> LAUNDHY TPAY _ WATER HEAT[R i <br /> CIOTHES WASHER _ METAL FIREPLACEISTOVE <br /> URINAL _ FIREPLACE INSERT I <br /> DRINKING FOUNTAIN _ GAS FIREPLACC <br /> FLOOR DRAIN _ GAS RANGE � <br /> �ACKFLOW PREVENTER _ GAS PIPING I, <br /> SINK (SERVICFJBAR/MOP/ETC.) __ EXHAUST FAN i <br /> OTHER _ OTHER <br /> — I <br /> I HEFEBY CEFIT!FY THAT I HAVE FEAD AIJD EXPMINED THIS APPLICATIOIJ AIJD KNOLV THE SAME TO BE TRUE AhD COR9ECT. ALL I <br /> pROVISIONS OF LAWS AND ORIDINACES GOVEPNING THIS NPE OF WOFK VJILL BE COh1PUED WITH WHETHEF SPEqFIED HEREIN OA � <br /> �' NOT THE GRANTING OF A°ERfd1T DO[5 NOT PRESUIdE TO GIVE AUThORIN TO VIOLATE OP CANCEL THE PROVISION OF AtJY OTHER li <br /> ST PTE OF LOC�L LAVv REGULATIWG COLSTPUCTION OR THE PERFORh1ANCE OF CONSTFUCTION. THFT I AM AUTHOPIZED BV THE i <br /> O'l:NER OF THIS PROPERN TO PERFORId THE WORK fOR WHICH APPLICATION IS h7AD[AND I COfdPLY WITH TNE STATE ' <br /> CCNTRAC��RS,LAVJ 18.27 RCW AND 2962GQ WAC. ,, I <br /> / �— � i <br /> (�Ca .v � r> E�..� '�� I <br /> SignaWre ol Ow er/Conlractor/Aulhonzed Agent Date i <br /> �L I <br />