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PcRMIT APPLIC�►TIt,N <br /> CITY C1F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25?-8810 - FAX 425-257-8857 / 7 I <br /> � L � <br /> _ �-�`,'Q�I_ � Uj <br /> SITE ADDRESS�II,/��+ � ,I I� � � I (� ,,I ,({ACEL TAX I.\. .� R'�11T q / <br /> \.'b 11c�� �r . � .�; _ �-c� ��o r, ���u- -��,:� I <br /> LeGA L0Y NO. �`j BLOCK %1 TRACT <br /> DESC. �j, I <br /> OWNER ADORESS ZIP PHONE � <br /> � <br /> �'�;��� C'_�[�_�, Ih��'� W���� �`r.i�l I ���� �d�'ll� , C�S�,`l� �����)33�I-��135� <br /> , <br /> 7ENANT NAME I \lG\�FC�\M'��\� \���11E��� _ � \� ) I� <br /> CONTFACTOR � �(1`� �{� �l i �\� ADOFE55 ZIP �CONTR.IICENiE N '� <br /> �♦ t � <br /> PHO� ,� , <br /> � �>�\��-h��� \�,v� ��,���' ���tC�y�.L q � � � <br /> PROPOSED USE OF BUILDING ��}}}}������((( Building I-1 hanica Additiun HEAT SOURCE <br /> � ` � � PERtdIT 'I ) Combination �_� Plumbing WORK Atleration �lectric <br /> TYPE H Gemolition LJ Sign TYPE New Gas <br /> V Sprinkler RepaidMaint Ocher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> ���L S-'( C—. .:� � ��/ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NU. 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 SINK& DISPOSAL = CLOTHES DRYER <br /> � DISH�VASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/5TOVE <br />� _ URINAL _ FIREPLACE INSERT <br /> I� _ DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> _ SWK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> GTHER OTHER <br /> ' — — — <br /> i — — — � <br /> I HEAEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIUN AND KN04V THE SAME TO BE TRUE AND CORfiECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNI�JG THIS NPE OF W09K WIIL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOE�NOT PRESUME TO GIVE:.UTHORITY TO VIOLATE OR CANCEL THE PROVISlON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AIiTHORIZED 6Y THE , <br /> ' OWNER OF THIS PROPERTY TO PERFOHtd THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT.ORS L�AW 1&27 R�4V AND 295200 WAC. �I <br /> �.� ° `\ C��,`�����. ���� �� � <br /> SignatJ e of�ne`v ohlractodAuthorized Agent Date i <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED �/� I <br />