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PE�-iII�IIT APPLICATIO� � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, bb'A 98201 --� <br /> 425-257-8810 - FAX 425-257-8857 /7 � <br /> — ��JaSic. 2�31 _ L-/7��/-U� <br /> SITE ADDPESS r� PARCFL TAX I.D. # <br /> PERMIT q P�'v7.rt-� <br /> � ' � �`� GOSSaSo 0 3 00 <br /> LEGA LOiNO. '3�j _ BLOCK TRACT <br /> DESC. �� � <br /> OWNER pw� YLo 3 Uo-k. �5 AD�RE55 <br /> � � P. �3 ZIP PHONE <br /> � �'�-�-1�-(���s�s ��. e l?03,�- i5 a�� sc 3�-1�11eit 4$0,�, Nd5-7k31718 <br /> TENANTNAME I CONTACTNAME <br /> PHONE <br /> - �r-yl� �G55�� �.�..5' �43'l i �g <br /> CONTRACTOR ADDRESS <br /> �� ��` ZIP CONP�. LICENSE p <br /> PHONE ���•�AI� i1-1.•C. Ilo3a.- 3s�}2u¢c'S� g'$6t� A�!xs2e�.o�a� t <br /> PROPOSED USE OF BUILDIIJG Building f'�Mechanical Additi-,n HE.1T SOURCE <br /> l�� �s,�y PERMIT ambinalion Il-.-�(�n�lumbing WORK {R-(�Alteration n Electric <br /> � � TYPE Demolition U Sign TYpE �"New It��( r_as <br /> Sprinkler U qepaidMainl V Othar <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ,�f�U2eri- �-O•,�nee. .lL.s./YNQU-�eQ�' . � . ' <br /> �� J� 0. ��q� . . <br /> I V �— � <br /> PLUMBING MECHANICAL <br /> ' NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I <br /> ,• �� WATER CLOSET A/C-A/HAND�ING UNITS <br /> .� BATHTUB � FORCED AIR SYSTEMS <br /> � _.(� LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> i _� KITCHEN 31NK& DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER 2� RANGE HOOD L(Y1�eQ�s) <br /> LAUNDRYTRAY � WATEP. HEATER <br /> , � CLOTHES WASHER � METAL FIREPLACE/STOVE <br /> ' _ URINAL FIREPLACE INSERT <br /> _ DPINKING FOUNTAW _� GAS r=iREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER �,z GAS PIPING <br /> _ SINK (SERViCE/BAR/MOP/ETC.) �_ EXHAUST FAN <br /> OTHER <br /> — - _ OTHER <br /> I HEREBY CERI'IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THc SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LA1NS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEP.SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES�VOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br /> OWNER OF THIS PROP'tPT1'TO PERFORM1I THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTFACTORS LAW 18,27 RCbV AND 296.200 WAC. <br /> �' ���, � I o <br /> Signzture I Owner/Contrac r uthorized Agent Dale <br /> ��z � <br /> --- ' � ►� -ci�� <br /> NF �3�9 <br />