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. , PERMIT APPL�(:ATION <br /> CITY OF EVERETT PEFiNliT �ERVICES <br /> �� 3200 CEDAR STREET, EVCRETT, 1•VA 93201 <br /> 425-257-8810— FAX 4L5-257-i3857 <br /> SITE ADDRESS PARCEL TAX I.D.If P MIT s �I <br /> XX �l �� �� �l�� R.l �� �� C��3�, • ��C� 3 �u�`_: - �,�, (,�� -(�3 <br /> LEGA LOT NO. 6LOCK TRACT <br /> DESC. S� � \ — ll �+F Lt I��� IUI �i�(X�Z. <br /> OW ER ADDRESS ZIP PHONE <br /> � ��'� �l) z5� <br /> -� ��o�l S� 3 �. ��.���. � � �� � ,�<< �� �t���N, ����� <br /> TENANT NAM1tE I CONTACT NAME / PHONE <br /> � (�. � <br /> L � DU��I �/Zr2�i -'i G, �G•c; <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE p <br /> �xG�� ' �\CJ4/�C1 1NC. . /�' � \ r3 C. . �.t�_ C ] IJJ� IZi..� ���JC��`tYY� <br /> PHONE �� `� <br /> �/zS zS5 v �au _ I� 5+z,,�N � :tiA y�z�� �RC.A2.N .i�Se = <br /> PflOPOSE� USE OF BUILDING I Building MeChaniCal Addition HEAT SOUR4E <br /> ([ �v ,� PEPMIT �Combination � PlUmbing WORK R Alterallon �Eleclric <br /> 1 TlPE Demolilion Sign TYPE � New Gas <br /> S`-1Z • I Sprinkler FapaidMaint. Other <br /> CONTRACT PRICE OF WORK �!� ��`�, CITY OF EVERETT LOCAL SALESTAiI CODE IS 3105 <br /> l ��l <br /> WORK OESCRIPT/ION ) / <br /> 'J�.�l \ � �� 1 � � �lf'V< /�. �fnH. '� �L�J� LI � N i ri <br /> ` J <br /> -��r Z� S< /� . K��'/�2//2� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> I � WATERCLOSET A/C—A/HANDLINGUNITS <br /> S BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) HEAT PUMP <br /> SHON/ER UNIT HEATEFS <br /> � KITCHEN SINK& DISPOSAL l CLOTHES DRYER <br /> 1 DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> l CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN 1 GAS FIREPLACE <br /> _ FLOOR DRAIN � GAS RANGE <br /> _ BACKFLOW PREVENTER ��_ GAS PIPING <br /> _ SINK(SEPVICE/BAR/MOP/ETC.) � .1� EXFIAUST FAN <br /> OTHER OTHER <br /> I HEREB'!CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOVJ THE SAME TO BE TRUE AND CORRECT. ALi. <br /> PqOVISI0N5 OF IAWS AND ORIDINACES GOVERNING THIS TYFE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREI'J OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY GiHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PEflFORMANCE GF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THI AOPEAT'Y- ERF ORK FOR WHICN APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> CONTRACT% LAW 1827 C 796.200 WAC. <br /> � U� . <br /> Signature o 1Conlraclod uthonzo Dat �\ �l3 <br /> / � <br /> _,....___ __ _. __ _ - ,. <br /> ,,-.. <br /> �! W�� _ / <br /> il.� . . . .. � .. ;• .. �'nn'E.:"`�.�"ti> 'w. ,Y.�. ���.. � � .. . . �� ^�i 1Ls`["`� r�.:.,..� :�7��:�. .�'i <br />