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r— - ---- ---- <br /> P�RMIT �►PPLICATI�N <br /> � ClTY OF EVERETT PERMtT SERVICE� � z}�,-� <br /> � 3200 CEDAR STREET, EVEP.ETT, lNA 98201 <br /> � 425-257-8810— FAX 425-257-8857 <br /> � SITE F6GRcSS i PARCEL ThX L�.: P�t"�� � � �. <br /> � I�IZ ��l "St-r�-f- �� , <br /> ILEGAL LOTNO. BLOCK TRACT I <br /> DESC <br /> OIRNER ADURESS ZIP PPONE I <br /> HerL�r�- 131z 3�1'^S+ree�- Evere�-r wA �S�-�, �� �� i� , <br /> 7ENAN7 NAfi9E CONTACT FOR PER�dii PHONE <br /> N/a I►1terl�tk Ind�+St��eS uZS '-I3S �SSS <br /> � COMTRACTOR � ADDRE55 ZIP CONTR.LICENSEit ' <br /> � In+�:,-Irxw Inclu���eS inc. I'�✓c> � sy-sw S^ u�.�]��e.E^ E�erett ir+���o1o�-c� , <br /> I PHONE _I�J I JO�Sry,� Wr1 -IOry"J '. <br /> I 7�� I <br /> PROPOSED USE OF BUILDING I `F� Building Idechanical `� Atldi;ion HEAT SOURCE - I <br /> PERMIT K Combinalion R Plumbing UORK S��Alieretion � E�ec�ric i <br /> ivpE u Demolilion � Sign 7YPE D New Gas <br /> U Spnnkler U RepaidMaint. Other <br /> CONiRACT PRICe OF NORK u �'J, CfTY OF EVcRETi LOCAL SALES 74X CODE IS 3105 <br /> ��� 1' 4V II <br /> WORKDESCRIPTION I �L�LCD�z- ��'(�-C(�j�f'�"X I�i <br /> S��PP�� an�d insi�U �nterr�x�- �i��n���n�+M �e,�q�i��y, T'e.�z ��� , <br /> � � �ers �� comPa�i; on <br /> PLUt�A61NG NIECHANICAL i <br /> NO. NPE OF FIY.TUP.E OR REM NO. TYPE OF FIXTURE OR ITEM , <br /> WATER CLOSET NC-NHANDLING UNITS <br /> I — FORCED AIR SYSTEMS I <br /> BATHTUB HEATPUMP � <br /> LAVATORY(WASH BASIN) — i <br /> SHO�NER _ UNIT HEATERS <br /> KITCHEN S `IK K DISPOSAL _ CLOTHES DRYER '� <br /> DISHWASh'�R _ RANGE HOOD I <br /> LAUNDP.Y' 4AY _ WATER HEAT�ER <br /> CLOTHES VlASHER _ METAL FIREPLACE/STOVE - <br /> URINAL _ FIREPLaCE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPL4CE I <br /> FLOOR DRAIN _ Gl+S RANGE . <br /> BACKFLOW PREVENTER GAS PIPING � <br /> SINK(SeRVICE/BAR/tdOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> — — i <br /> � — ---- — I <br /> — I <br /> — � <br /> I HERE6Y CERITIFY THAT I HAVE READ AND EXAMINeD THIS APPLICATION AND KNOW THE SAME TO BE TRUc AND CORRECT. HLL I <br /> IIPROVISIONS OF LAIMS AND ORIDiNlCES GOVERNINu THIS 11'PE OF 11'ORK 11'ILL BE COMPLIED N�ITi-I lM1'H�T4ER SPEQFIED HEREIN OR '� <br /> NOT. THE GRANTING OP A PER1.71T DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHcR <br /> STAI E OR IOCAL LAW REGULAiING GUNSTRUCTION OR THE PcRFOR69hNCE OF CONSTRUGTION. THAT I AM AUiHORIZED 8Y THE <br /> I OINNEROF iH15 PROPERTY TO PERFORRI THE\NORK POR tA�HICH hPPLICATION IS I.1ADE AND I COh1?LY WITH THE STATE <br /> i <br /> CONTRACTORS LhvJ t .�7 RC4V AND 2962001�JAC. <br /> � �� �,�, n�h ��1 . �?D���- <br /> � <br /> Signzture e:. .!Con7zctoV.�:: o.^._etl A;snr D_._ <br /> I `� —— —_i <br /> DEBIT& CREDIT CARDS ARE NOT ACCEP7ED <br />