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i <br /> �''ERMIT APPLIC�4��ON <br /> CITY UF EVERE'TT PERMIT SERVICES <br /> 3200 CEGAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 � <br /> SITE ADDRESS�/� PARCEL TAX I.D.N <br /> �%�/ 7//7^T �� ERMITN <br /> c(O J/ oo9yo 7- ooa--vi - • v �L12 -� <br /> LEGA LOT N0. BLOCK TRACT <br /> oesc. �z �i E�y�o�L IP(y,�l� <br /> OWNER �/� qQ <br /> �.�i4c�l�/t�'S it/,K� T�r�/L /�j/(ORSa LK��-'�NS !� ZIP PHONE <br /> GK s�..�s 96'zs� ��fts�3jy� oS7� <br /> TENANT NAME COrITACT NAME <br /> PHONE <br /> ��,r/ �fa���� yzs-33yo.s�3 <br /> CONTRACTOp '/ <br /> �Y�C' ,/gL-J ryu� ,�'�/°� ADDRESS <br /> ,/ [ ' /� ZIP CONTR.LJCENSE/ <br /> 1 �� . �'���J .iC� �iKG..�1s'kMh'� � • <br /> PHONE <br /> y'1s-33�/-6s7 3 � - CC s��� 9F�zs�� LE��k,Y�/°yyPK <br /> PROPOSED USE OF BUIL�ING � � Building Mechanical <br /> // PERMIT � Combination R Plumbin Addition . HEA7SOUqCE <br /> s�K TYPE Demolition 9 WORK Alleration � Electric <br /> D Sign lypE New Gas <br /> Sprinkler Rapair/Maint. Other <br /> CONTAACT PqICE OF WOqK CITY OF EVERE7T LOCAL SALES TAX COOE IS 3105 <br /> WORK�ESCRIPTION n � <br /> L:-O�/.iRt�1C� .SI'I'� ► Q/Tv�� ��� � <br /> IPLUMBING MECHANICAL <br /> NO• TYPE OF FI%TURE OR ITEM <br /> NO. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLI��G UNITS <br /> � BATH7UB � FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> = SHOWER <br /> � KITCHEN SINK 8 DISPOSAL UNIT HEATERS <br /> DISHWASHER � CLOTHES DRYER <br /> � LAUNDNY TRAY � RANGE HOOD <br /> � CLOTHES WASHER WATER HEATER <br /> = UFINAL — METAL FIREPLACE/STOVE <br /> = DRINKING FOUNTAIN — FIREPLACE INSERT <br /> � FLOOR DRAIN GAS FIREPLACE <br /> I = BACKFLOW PREVENTER GAS RANGE <br /> � SINK(SERVICE/BAR/MOPiET�;.) GAS PIPING <br /> _ OTHER EXHAUST FAN <br /> _ OTHER <br /> i — — <br /> � — <br /> I HEREBY CERITIFY TFiAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> . PROVISIONS OF UWS ANO ORIDINACES GOVERNING THIS NPE OF WOqK WILL BE COMPIIED WITH WHEfHER SPECIFIED HEREIN OR <br /> ! NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � S7ATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE PERFORMANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OP T S P OPEP.1'TO PERFORM THE WOpK FOR WHICH APPLIL'ATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT 1 7 RC 296.200 WAC. <br /> ������.� �,� z�-�� <br /> Signalur o wnedContractaVAulhonzed Agent Dale <br /> ��Z <br />