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( PERMIT �APPLIC�TION <br /> Cl i'Y OF EVERETT PERMIT SERVICES <br /> 320Q CEDAH STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 \ � <br /> "af 36 � l� �r��- �� <br /> SITE ADDqESS PARCEL TAX I.D.A <br /> 9l�+�.S_ Z S � �Q �S� G .Y' % 7» PERMR M <br /> LEGA LOT N0. BLOCK p� � �� � 3�Y—��O 'a <br /> � DESC. 2^Ll. l<4L'!/,f/� � <br /> OWNER r ADDRE33 ' <br /> «I� SO L9/�,j�j,.u✓J,�� �P PHONE <br /> �K�cs/ f��'!/1 71,�t� .�'�r/G. �i� ��r�:�S ���f' <br /> TENANTNAME I <br /> CONT NAME PHONE <br /> CONTRACTOR /X�/��"�`-� �Z,5��7_OS� � <br /> Ce�r�efi .S�•rus �JGfJ.�/�ADDRESS ZIP CONTp.UCENSE/ <br /> PHONE <br /> yzs-33y or�3 - ���l,d��.y,eK <br /> PROPOSE�USE OF BUILOING Building <br /> Mechan(cal � Addition HEA7SOURCE <br /> PERMIT Cambination Plumbing WOHK �iteration <br /> S'C/J TYPE Dem01iti0n Sign TYpE N�:� � ��� <br /> � �� Sprinkler Gas <br /> _ RepaidMainL Other <br /> CONTqqCI'PRICE OF WORK C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> JT� I <br /> /5�.�,G.� Z.Z� <br /> IPLUMBING MECHANICAL <br /> N0. TYpE OF FIXTURE OR REM <br /> NO. TYPE OF flJfTUflE OR ITEM <br /> �, WATER CLOSET '�"' A/C—A/HANDLING UNITS <br /> � BATHTUB <br /> � LAVATORY(WASH BASIN) Z FORCED AIR SYSTEMS ' <br /> = SHOWER = HEATPUMP <br /> �_ KI?CHEN SINK 8 DISPOSAL — UNIT HEATERS <br /> � DISHWASHER _L CLOTHES DRYER <br /> `— LAUNDRY TRAY � RANGE HOOD <br /> � CLOTHES WASHER , WATER HEATER <br /> URINAL = METAL FIREPLACE/STOVE <br /> DRINKING FOUNTAW '�- FIFEPLACE INSERT <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACKFLOW PREVENTER � GAS RANGE <br /> SINK(SERVICE/EAF/MOP/ETC.) � GAS PIPING <br /> OTHER S EXHAUST FAN <br /> —'—'-- = OTHER <br /> �— <br /> � -T _ <br /> , , — <br /> I HEREBY CERI7IFY THAT I HAVE FEAD AND EXqMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GqANTING OF A PERMIT OOES N07 PRESUME TO GIVE AUTHOq�7y TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHEH � <br /> S7ATE OR IOCAI LAW REGUL4iiNG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br /> OWNER OF THI PROPEFiTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRA R LAW.18.27 qCW 96.20p WAC. <br /> �/�1���� 5=� 9= p� <br /> Signa re Owned ontracrodAuthonzed Agent ate � <br /> � L <br />