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PL�.�MIT APPLICATI�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS ppRCEL TAX I.D.N PERMI7 x <br /> /So/ •- 5/ ?�" pc S; k/ 392 0 - -D 8-aoo� <br /> LEGA LOT N0. BLOCK 7RACT <br /> DESC. �,..,� <br /> OWNER ADDRESS ZIP PHONE <br /> .�q c�y �o�c,��� ���i�� l�5 o i � y S r'�,�� 5�[! 5'd'za� �5`�r� 25�,�3y <br /> TENANTNAME CONTAC7NAME PHONE <br /> Cf�LI/i �1 >�'r�klo. ?- I dJ 2 I - S 0 <br /> CONTRACTOR ADDRESS ZIP ONTR. LICENSE M <br /> PHONE � �. <br /> PROPOSED USE OF BUILOING Building � Mechanical � Addilion HEAT SOURCE <br /> PERMIT Combination Piumbing WOHK Allaration [� Electric <br /> SL TYPE Demolition Sign 7YpE New N�U Gas <br /> /(JQjq 'e- Sprinkler fiepair/Mainl. U Olhe� <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> WOqK DESCRIPTION � <br /> ExR9�t�o �xr.s n%r� ��,r� ��, Y �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYpE OF Fl7CTURE OR REM <br /> _ WATER CLOSET _ A/C-A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATCRS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> I _ DISHWASHER _ RANGE HOOD �/� <br /> _ LAUNDRY TRAY , /� _ WATER HEATER <br /> I = CLOTHES WASHER /V _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPIACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> � _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I _ — <br /> I — <br /> i — <br /> i � <br /> � <br /> � �HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEftiER SPECIFIED HEREIN OR <br /> i NOT. THE GRANTING OF q pERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER i <br /> � STATE OR LOCAI LAW REGULATING CONSTRUCTIpN OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 R9 W AND 296.200 WAC. <br /> --//, l�.� �FY�Xn.i iC � <br /> i �g,nature of Ow� r/ ontractodAu/t'tjbrtzed Agent D te <br /> I V <br /> — li <br /> � <br />