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4, �InJiT /(c <br /> �CRMIT APPLICATIaN P�-�-� '�38� <br /> CITY OF EVERETT PERMIT SERViCE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-3857 <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT� <br /> 9�I 3 o I�?µ .�R��� �J � _ l� �� <br /> �=G:.Vi LOT N0. � BLOCK TRACT <br /> �Fs�.f l6 ��G us,—N c.�� ���os <br /> OWNER DDRESS ZIP PHON <br /> (yu�3s� -youo <br /> _�",��T ;�f w,E�3�� ,L � �;ns ,_r,� c . PoQ�,r�s79 I�a�dw�,�f/ �JA ����1 � <br /> TENANTNAME I CONTACTFORPERMIT � PHONE I <br /> CONTRACTOR ADDRESS — <br /> �,�i T �D �So�( /.5�"y � .SNc)Ffv+`1l .frai �H `�ij'L9/ GONIYN-�fE+FOd'S-/n 3 <br /> PHONE <br /> ��L� � j�7 3 '�OOU CKQ /���tJ�uoS <br /> PROPOSED USE OF BUILDING Btlild'I�g Mechanical Atldition HEAT SOURCE <br /> ' / PERMIT �¢ Combinalion R Plumbing IWORK R Alteration I n Eiecr�c <br /> /��Z.� /�h'u.S� �,�x1S,y'Lt�'!`t rYPE �� Demolition D Sign TypE DZ» New IQj <br /> I Gas <br /> s r- �� D Sprinkler d Repaiutifainl. L Oiher <br /> CONTRACT PRICE OF WORK �4 Gj�v 00 CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> WORK DESCRIPTION <br /> s F/'� �a S/ C Z Z `�,3 � <br /> PLUMBING MECHANICAL <br /> NO. i NpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �NATEk CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> 1 BATHTUB 1 FORCED AIR SYSTEMS <br /> �3 LAVATORY(WASH BASIN) HEAT FUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES ORYER <br /> _L DISriWASHER ,L_ RANGE HOOD <br /> ^ LAUNDP,Y TRAY _L WATER HEATER <br /> = CLOTHES VVASHER METAL FIREPLACE/STOVE <br /> = URINAL FIREPLACE INSER7 <br /> ORINKING FOUNTAIfJ 7 GAS FIREPLACE <br /> � FLOOR DRAIN / GAS RANGE <br /> 1 BFCKFLOW PREVENTER GAS PIPING <br /> _i SINK (SERVICElBAR/MOPIETC.) � EXHAUST FAN <br /> _iOTHER OTHER <br /> —� <br /> � ncRE3Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUe AND CORRECT. ALL <br /> ��C\'i90NS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED WITH WHETHER SPECIFIcD HERcIN CR <br /> ':C' TH"c GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE GR CANCEL i HE PROVISION OF:.NV pTr.cR <br /> �TA i E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM ACTHORIZED 9v T1,= <br /> ✓'.'dNER OF TNIS PROP RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATc <br /> :;.'�,r17 C70RS LAW 1 27 RCW AND 296.200 WAC. <br /> �'� � /L/3J �'3 <br /> S:gna�ure ot wnedContractorlAuthorized Agent Date <br /> ❑EBIT 8 CREDIT CARDS ARE NOT ACCEPTED l/L <br />