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f'�RIVIIT APPLICATI� 'V <br /> CITY F EVERETT PERMIT SERVd�ES <br /> 3200 CEDAR STREET, �VERE7T,WA 98201 , <br /> 425-257-8810- FAX 425-257-8857 <br /> P� �o � -�1/ <br /> SITE ADDRESS PARCEL TAX;.D.1 PERMIT� <br /> 9YvZ/ ZS�' �l� s� fiY� 07-�-039-� t�° a�0`��00 <br /> LEGA LOTNO. BIOCK TRACT <br /> DESC. j � ��j/� <br /> OWNER ADDRESS ZIP PNONE <br /> /B/6 .So Llc�iF.w.�s �c✓ <br /> 1.���s �w�� �,� �, � s�z.s� C��.�'y-as-�3 <br /> TENAh'�NAME I CONT CT NAME PHONE <br /> _ � irt/ ��� �/ts—.���/�3 <br /> CONTRACTOR A DRESS ZIP CONTR.UCc'NSE N *,�� <br /> PHONE S'�� ^ <br /> �� L��.��r/oyy�,1� <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT Combination 1R...1 Plumbing WORN Alleratlon RElettric <br /> ��// TYPE Demolilion u Sign 7YPE � New Jeq Ges <br /> K Sprinkler Repaididaint. U Other <br /> CONTRACT PRICE OF WORK CfTY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> WORK�ESCRIPTION <br /> S�� . <br /> ,c �Zz1�" <br /> PLUMBING MECHANICAL <br />� NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> IZ WATER CI.OSET ^ A/C—A/HAND�ING UNITS <br /> —� BATHTUB _L, FORCED AIR SYSTEMS <br /> I � LAVATORY(WASH BASIN) = HEAT PUMP <br /> SHOWER — UNIT HEATERS <br /> _L KITCHEN SINK 8 DISPO: `.L _L CLOTHES DRYEF <br /> _L DISHWASHER _L RANGE HOOD <br /> -- LAUNDFY TRAY _L WATER HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL — FIREPLACE INSERT <br /> DRINKING FOUNTAIN Z GAS FIREPLACE <br /> FLOOR DFAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br />� <br /> OTHER _ OTHEF <br /> I _ — <br /> I HEREBY CERITIFY THAT 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 UF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br />, NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER - <br />� STATE OR LOCA LAW REGULA7ING CONSTRU:TION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV TFiE <br />� OWNER T I PROPE TY TO pE .ORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTR U1W 7 R A WAC. <br /> 9--�0� <br /> Signalur ol Owner/ConiracladAuthorixed Agent ate � <br /> ,� <br />