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PE�'VIIT APPLI�ATIO�� I! <br /> CITY OF EVERETT PERMIT SERVICES ��J�Q ,���Z � <br /> 3200 CEDAR STPEET, EVERETT, WA 98201 I <br /> 425-257-8810 - FAX 425-257-8857 � <br /> ',c3- ��-� <br /> SITE ADDRESS PARCEI TAX I.D.q ERh11T d <br /> 1300 S�/sT Sr2�E7 a�s2oaocn0000z � 0�08 - �2� <br /> LECAL LOT N0. BLOCK 1'RACT <br /> DESC. f lg cvE2�,2rcN G'r.�1FT42y SrvE'J7y i� DD � <br /> OWNER AD��3ESS ZIP PHONE <br /> �[/Z/ZoN /CCX> 4/sT ST2�rT 9$ZOl �{ZS. Z6/. S3Z/ ' <br /> TENANT NAPo7E CONTACT NAME PHONE <br /> V E21 ZoN I s�zS, z6/, 53z1 I <br /> CONTRACTOR A�DRESS ZIP CONTR. LICENSE q <br /> f A7i2/��T F/2 E �'i2o-rEcrioN <br /> PHONE <br /> z53 . `>Z6. 2_Zyo z7o� 7oTH ��vE t' TACau4 yS`fz� ?�Ti21FPoyqcr- <br /> PROPOSED USE OF BUIL�WG Building tdechanical I Addiiion I HEAT SOURCE <br /> PERMIT Comhinalion R�...f Plumbiny WORK Allemtien Electric <br /> TF�✓�aNT /�`!�/2Uvt,�1SNT TYPE Demolilion U Sign TYpE Plew R�–( Gas <br /> — Sprinklef Repair,?.1ainL V Other i <br /> CONTRACT PRICE OF WORK � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 '' <br /> WOFIK DESCRIPTION <br /> J+�f�/!ZELOGATE S/�i21NKLEll_ HF!{DS F�2 TfNANT /MP/ZUutME/J7- I <br /> P� 2 P(F Pi� r3 I <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITE�d NO. NPE OF FIXTURE OR ITEM �"- �L., <br /> �= .7 <br /> _ WATER CLOSET A/C-AlHANDLING UNITS ,` [r ��,I <br /> BATHTUO _ FORCED AIR SYSTEMS LU Lt� <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP � Q. r��� <br /> _ SHOWER UNIT H[ATERS �� \ <br /> .___ I(I�CHEN SINK & DISPOSAL _ CLOTHES DRYER J� C - <br /> _i DI�HWASHER RANGE HOOD !� � <br /> LAUNDRY TRAY � WATER HEATER 't <br /> CLQTHES `NASHER ' �I � ' METAL FIREPLACE/STOVE � � I <br /> URINAL " y FIREPLACE INSERT �. w �I <br /> DRINKING FOUNTAIN �' � r �� GAS FIREPLACE � � <br /> _ F�OOR DRAIN ✓ �� � GAS RANGE (j j � <br /> BACKFLOW PREVENTER � GAS PIPING � <br /> _ SiNK (SERVICEiBAR/MOP/ETC.) ("J� _ EXHAUST FAN (� � <br /> OTHER /"� � OTHGR <br /> _ _ I � ,'� 8`� ADD�/2Et.ocATE sDRiN.KLERS <br /> — . <br /> I HEP.E!3Y C[P,ITIFY THAT I HAVE READ AND EXA611NED 1 HIS APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORRECT. ALL <br /> PROVl510N;0°LAWS AND OFIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOI. THE GRANTING OF A PERMIT DOES NOT PAESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION GF ANY OTHER <br /> STATE OR LOCAI.lAW REGUTATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWfJER OF THIS PROPERTY TO PERFORM THE WOFK FOR WNICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br /> 'RACTCIFS lAW 1827 RCW AND 296.200 WAC. <br /> ' ---=�-Y---��Z �o. �. or <br /> SignaNre of JwneriConirac orC /Authorized Agent Date <br /> Y .__._-.. . <br /> � <br /> I " / <br /> 1 . <br /> �� <br />