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P�RMIT APPLICAT!'1N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 , <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PAR:;EL TAX I.O.M PERMIT k <br /> C` . _ r i ��. -, r'� �� C/� /� �// ` <br /> ���C= � �-_� � ��. �1F- G�`J�/L/� •Ci�"�C/'�1J�'� L'��.1 �V/ � O `Or7 `-+ <br /> LEGA LOTNO. BLOCK TRACT / ` <br /> DES0. > y/ �/� <br /> OWNER < � X{?�f���-Y • C,��� <br /> ADDRESS (.Y _SJtw.�/5 i�;;C'S�=J ZIP PHONE <br /> ���L'���� � /�:(�/i'it� � /��i ':��/�� �LF)�l�' i�.% ��i%l JIC��l'i ,C,!/ ��! �'�J/��.�J/� <br /> TENANTNAME I CO ACTNAME <br /> / / 1'HONE <br /> - / �'���"(� ✓/Ci��//I c��i- � ._ ��/ > � <br /> /1S� /-cs 7� <br /> CONTRACTOH ADDRESS <br /> �/, , �.t. _. 21P CONTq. LICENSE M <br /> ---ri ��'.. --- -- <br /> PHONE <br /> � � � _FCfl�'tfNc'h�'�k'K <br /> PROPOSED USE OF BUILDING Building f'� Mechanical I�"1 qdctilion HEAT SOURCE <br /> . � PERMIT � Combination K Plumbing wORK �--� Nteralion � Electric <br /> ,;�i� TYPE Demolition U Sign 1YPE j�7 New Gas <br /> _ Spiinkler U Aepair/Maint. Other <br /> I CONTAACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> i <br /> WORK DES:RIPTION <br /> I , , - <br /> -5/-�. � <br /> :-< _ <br /> ��;s - -r�- � � � � �. � ����,5� /�;,,/ <br /> r1 ,: < < <��. <br /> � PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM <br /> i P10• TYPE OF FIXTURE OR ITEM <br /> �' WATER CLOSET '- A/C-A/HANDLING UNITS <br /> �_ BATHTUB �_ FORCED AIF SYSTEMS <br /> _ LAVATOFY (WASH BASIN) _ HEAT PUMP <br /> - SHOWER <br /> ! KITCHEN SINK& DISPOSAL ""' UNIT HEATERS <br /> � DISHWASHER � CLOTHES ORYER <br /> — LAUNDFiY TRAY �_ RANGE HOOD <br /> � CLOTHES WASHER � WATER HEATER <br /> URINAL _ METAL FIREPLACFJSTOVE <br /> � DRINKING FOUNTAIN - FIREPLACE INSERT <br /> � FLOOR DRAIN _L GAS FIREPLACE <br /> BACKFLOW PREVENTER �- GAS RANGE <br /> � SINK (SEFVICE/BAF/MOP/ETC.) �! * GAS PIPING <br /> �/ � EXHAUST FAN <br /> � OTHER ,_ OTH[R <br /> _1 <br /> �' — <br /> I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APFIICATI7N ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF t,4W5 AND OFIDINACES GOVERNING THIS TYPE OF WORK WILlBE COMPLIED WITH WHETHEP SPECIFIED HEREIN OR <br /> NC7. TNE GRAPJ7ING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORIIV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION CR THE PERFORMANCE OF �ONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER�PF jHIS pROPERN TO PERFOqM THE WORK FOR WHICH APPLICATION IS MADE ANU 1 COMPLY WITH THE STATE <br /> CONTAAFJOF�,4'lAW 18,27�tlVqN�:296.200 WAC. <br /> i!./� j-����i._ �� �'� /�' �/ � <br /> � <br /> SignaWre of Owner/Contractor/Authorized Agent Daie <br /> r2 <br />