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�.. PERMIT APPLICATIOIv <br /> E,,�„ CITY OF EVERETT PERMIT SERV��ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 ' ` i9�� <br /> SITE ADDRESS �;}� PARCEL TAX I.D.x PE9t.�11T; I <br /> :%l,`W -u1.�.1/ C'�' \'_(�u� �� G/ -��; <br /> LEGAL LOTNO. BLOCK TRACT I <br /> DESC. <br /> nwucq � ' ADDRESS -!., PHONE �� <br /> �=�c. � i�-1��r��c;�� . <br /> TENANT NAME 1 CONTACT NAME PHONE I <br /> rc' �.��� ����rv��u���� ����,l�q.� <br /> ��1 � ' - - <br /> C�ONTRACTOR � �DFESS I � � CONTR. LICENSE r <br /> �.e�l'YIGJ�s�.11,Z.l �,rc �Yi�tt���lu'� ; � � � 2 � � <br /> PHONE c � � ; ���u��-�- v �� +��� 1,�.�rl ciS2'13 ���ne��3Zm�� ,�. <br /> �1��, '�-1`� iL�i _ <br /> PROPOSED USE OF BUILDING Building � tvtechanical Accincn HEAT SOURCE <br /> PERMIT �Combina�ion Plumbing WORK �Al;eraticn D Elec:nc <br /> TYPE Demalition Sign TYPE New �> Gas <br /> Sprinkler RepairiM1laint. U Other <br /> CONTRACT PRICE OF WOflK Z�'L CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I, <br /> WORK DESCRIPTION ; <br /> �1�_�I���-� 7 (v'�.�� r!�.r�� <<Lcc�cl.� ��� -�-� �l,i�i��-��.-y'' �I <br /> C�l .C� I �:�{�'� , 1`��' ��v�cl�r� ����i�S�'c+ c�,uc-4- ��rr1 '�, <br /> PLUMBING MECHANICAL III <br /> N0. TYPE OF FIXTURE OR ITEh7 NO. TYPE OF FIXTURE OR ITEht <br /> WATER CLOSET _ A/C–fv'HANDIING UNITS II <br /> BATHTUB _ FORCED AIR SYSTEMS �, <br /> LAVATORY(WASH nASIN) _._ HEAT PUA1P �' <br /> SHOWER _ UNITHEATERS , <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER , <br /> DISN4NASHEF _ RANGE HOOD � <br /> LAUNDRY TRAY _ VJATER HEATER . <br /> CLOTHES WASHER ._ �1ETAL FIREPL4CEiSTOVE ', <br /> � URINAL _ FIREPLACE INSEFiT ' <br /> �, DRINKING FOUNTAW _ GAS FIREPLACE � <br /> FLOOR DRAIN _ GAS RANGE <br /> �� BACKFLObV PREVENT.EH _ GAS PIPING ' <br /> �I _ SINK(SERVIC68APoMOP/ETC.) � OTHERST FAN , `� <br /> OTHER , <br /> — — i <br /> 1 HEREBY CERITIFY THAT I HAVE RE;1D AND E�CAh71NED THIS APPUCATICN AND KNOIV THE SAL1E TO BE TRUE AYD CORRECT. ALL I <br /> PROVISIONS OF LAWS AfJD ORICENACES GOVERNING THIS NPE OF WORK IYILL BE CC�'PLIED WITH SYHETHEP�SPECIFIED HEREIN OR <br /> NOT. THE GPAYTING OF A PEflAfIT DOES YOT PRESU1.fE TO GIVE AUTHOF,IN'O VIOL4TE OR CA'JCEL THE PROVISION OF ANV OTHER ' <br /> STATE OR LOCAL WN REGULITING CCNSTRUCTION OR THE PERFOFh1AtJCE OF CONSTnUCTIODJ. THAT I AAt AUTHORIZED 6Y THE i <br /> � OWI�IEF THIS PROPERTY TO PERFORAI THE 6VORK FOR WHICH APPLICATION iS'.tAOE AND I COh1PLY WITH THE STATE il <br /> ' CO�TRAC RS L1W�8.2j RCIV AND 25b.<CO WAC. , <br /> ^ <br /> � !' ';��� � 1- I �� �� ;� <br /> �. <br /> I Signature �f wner,�CoNractouAuthonzed Agent Date I <br /> I <br /> L_—'---- <br />