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� <br /> ---- ( — <br /> � PERMIT APPI.ICATION <br /> CITY OF EVERETT PE'RMIT SERVICES <br /> i 3200 CEDAR 5TREET, GVERETT, WA 98201 <br /> i 425-257-8810— FAX 425-257-8857 <br /> I <br /> ISITE ADDnRrESS 1 (l ��. PfARCEL TAX I.D,.#' I PE T a <br /> `\�J� �- 'I10� ` t'�• �iV • V.�+t�� nLt\,1,�1 `7�tC� � Z7� <br /> LEGA LOTNQ. BLOCK TRACT p� f <br /> DESC. ,'� ( Z LOG 1 �N��� y `.ST�T�-S <br /> OWNER ADDRESS �IP PHONE -� • <br /> � �` _1� �:1 �,t7. , l .�c� � �� I0 S�u/��L�/��LlN4S �Ay 5�,���10 �,�f� 9d��7�� i <br /> TENANT NAME CONTACT NAME � t y Z�� PHONE � <br /> ' G �C � <br /> j�,'�;, �A�F ��IG' r3cG 3�`I -54s5, ��/-.sys�, �3o-�;{Z� ; <br /> CONTRACTOR ADDRESS ZIP COIJTR.LICENSE N � <br /> I <br /> PHONE � �� �� �r CO �DCI �fO� �rvG I <br /> � ev P, /V�Z2.�o3 � <br /> PROPOSED 11S[OF 6UILD�YG Building f� Mechanical Addilion HEAT SOURCE � <br /> PEFMIT Combination YR-�Y Plumbing WORK R{._( Alleradon Electric I <br /> � � TY?E Dernolition U Sign TYPE {� Nex � Gas <br /> -i n �� � Sprinkler(a of heads) U RepairFdaii�. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX Cn�E IS 3105' <br /> WORK DESCRIPTION <br /> j��;;.J � ( I � = <br /> (' A1 �� (� I <br /> 1_Jl�'`'1 C_ � _.a�_:_.��=----�-� I <br /> PLUMSING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> I ��. BATHTUB � FORCED AIR SYSTEMS <br /> '? !AVATORY(WASH BASIN) HEAT PUMP <br /> � SHpWER UNIT HEATERS <br /> � KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> I DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � J_ CLOTHES WASHER METAL FIREPLACE/STOVE I <br /> _ URINAL FIREPLACE INSERT � <br /> ORINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE / <br /> BACKFLOW PREVENTER � GAS PIPING J <br /> _ SINK(SERVICE/BAR/MOP/ETC.) L EXHAUST FAN `,�` I <br /> _ OTHER _ OTHER �I1 <br /> U <br /> — _ �� <br /> I HEREBY CERITIFY THAT I HAVE READ R,ND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINFCES GOVERNING THIS NPE OF WORK WILL BE COMFLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THF GRANTING OF A PERP✓11T DDF.S tJOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THFT I AM AUTHORIZED BY THE <br /> OWNEH OF THIS PROPERN TO PERFOFM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> COMTRPCTC�RS LAW 18.27 RCVJ AND 290.200 VJAC. <br /> i � � � � <br /> I • l��� .� ��.�.(i��.�"i � �G O� <br /> I Signa�ure of OwnedContractor/Aulhorized Agent Dale �/ <br />