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� , <br /> P�'riMIT APPLICATIO�v <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.i I PERMI7 p � <br /> ' f l ��i4�lE5C- 8� -108 PN���SI�{� Oo1o160J p� O �rb� -O <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. ON (J�NS <br /> OWNER A�DRESS LP PHONE <br /> /`�f A(ZI��I E2 S Q uA2t_.s�N Ul.,'S'1�/�tt=N 1 S �?v. �3 ox(0 55 S/ror,'o�rs,N.i.�w 9�.z11 <br /> TENANTNAME CONTACTNAME PHONE <br /> 7r/�.✓G'ILLAIGC.r t��i4/,� SRLDN �c�Qy /'i1Al�Z/L1L �'1.15�-77�1—Fj$`�� <br /> CONTRACTOR ADDRE S LP CONTR.UCENSEN <br /> �G`�/Yr�'J/G HC.CNfaN�GAL �NG. Pp• (3u�'S3a.LLyNN[tt1�f/� `���Yh �Gy/I?�/Y,+1I70aJ <br /> PHONE <br /> c-l��-���+ -Sf3'-1 � <br /> PROPOSED USE OF BUILDING Building i Mechanical Addition HEAT SOURCE <br /> PERMI7 R Comhinalion �_�� Plumbing WORK � Al�eralion � Electric <br /> TYPE D Demolilion LJ Sign TYPE New Gas <br /> ���AlL D Sprinkler RepairRAaint Other <br /> CONTRACT PHICE OF WORK ` `�L�� os! . CITY OF EVERETT LOCAL SALES TAX CODE'S 3105 <br /> WORK DESCRIPTION �S T LL �— 3TON'�aS�G�LL-�IRJG N V/4G UNI I Gtll I � SuP�.�1Cfj� / <br /> �JSTRLL l C.>?CNAU�(' FNN� JCAS�Tj��' / /.�UAG UN!!� I�L'NT��� �.�iQ�G�2 <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET � A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN S�NK 8 DISPOSAL 1 CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER 1 GAS PIPING <br /> SiNK(SERVICE/BAR/MOP/ETC.) ._[_ EXHAUST FAN <br /> i _ OTHER OTHER <br /> iI HEREBY CERITIFY'HAT I HAVE READ AN�EXAMINED TH���.S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1WS AND ORIDINACES GOVERNING THI;�TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PHOVISION OP ANY OTHER <br /> I STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERPORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> i OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT CTOFS LAW 18.27 RCW AND 296.200 WAC. <br /> ./�.r/� 'Z 20 � <br /> Sign ure of nerlCo acmr/Authorized Agent Dale ��L <br />