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�ERMII' APPLICA-'ON <br /> CI OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, V1�A 98201 <br /> 425-257-8810-FAX 425-257-8857 � <br /> SITE ADDRESS � PARCEL TAX I.D.M PE��R� <br /> ���z 25 ��C sc G�a��ro7- ��o_o3z _ov I C �'>r��- Ov3 <br /> LEGA LOT N? BLOCK Tpq <br /> DESC. �� �����`�� <br /> OWNER � <br /> // ADDRE55 ZIP pHONE—�� <br /> ��.Y:/ l�C� �,� ��s/��.Soil,s/er.rws" !�� <br /> i14's 7f./�� ' LC ��.✓S ��� `/s'S-�'_��OS 73 <br /> TENAM1 •'•••� I CONTAICT NAME -- <br /> �� PHONE <br /> CONTRACTOH '� � L//v ����C�'�=�� l�IS .�3�-JS"7j <br /> ADDRESS ZP CONiR.L10ENSEM <br /> PHONE <br /> PROPOSED USE OF BUILDING L ��C��O�l�� <br /> Building � Mechanical Addition HEATSOURCE <br /> PERMIT Combinalion Plumbing WOqK �R,..( Alleralion n <br /> ��^ TYPE Demolitiun Si n ������ <br /> !� 9 TYPE {�New as <br /> l� Sprinkler U Repair/Maint. Other <br /> CONTFACi PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION <br /> 5Fk' , " • <br /> �,s,c l�,y <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR REM <br /> NO. TYpE OF Fl7CTURE OR ITEM <br /> WATER CLOSET '^ PJC—A/HANDLING UNITS <br /> L BATH7UB _L, FORCED AIR SYSTEMS <br /> �_ LAVATORY(WASH BASIN) = HEAT PUMP ` <br /> �— SHOWER — UNIT HEATERS <br /> _L KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> —L_ DISHWASHER _L RANGE HOOD <br /> "'' LAUNDRY TRAY �[_ WATER HEATER ' <br /> � CLOTHES WASHER = METALFIREPLACFJSTOVE � <br /> UFiINAL -- FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN �_ GAS RANGE <br /> I BACKFLGW PFEVENTER � GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) �� EXHAUST FAN <br /> OTHER <br /> _ OTHER <br /> �— <br /> � <br /> _ � <br /> _ <br /> 1 HEAEBV CERITIF�!iHAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISiONS OF LAWS AND OFI�INACES GOVERNING THIS TYPE OF WORK WILL BF COMPLIED WITH WHEfHER SPECIFIED HEREIN OFl <br /> NOT. TNE GRANTING OF A PERMIT DOES NO?PqESUME TO GIVE AUTHOqITY 70�:�OLATE OR CANCEL THE PROVISION OF ANY OTHER � <br /> SiATE OR LOCAI.LAW qEGULA7ING CONSTqUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br /> OWNE�I OF THIc pROPEFTY TO PEFFORM THE WOFK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTR ��Z��C/�200 WA� <br /> ��' /�o� <br /> Signawr of Owner/Contractor/Authorize ,4gent 8�9 <br /> �/Z <br /> i <br /> i <br />