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�, <br /> . � <br /> � PERMIT APPLICATION <br /> i CITY OF EVFRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EV�RETT, WA 96201 <br /> 425-257-8810- FAX < 5-257-8857 n l��_ O I,, <br /> �'�l/ <br /> SITE ADDRE,jS��—I I I''�` 9 , �\� ' �I �PARCEL_iA� p�)��� I PEFiM?X � <br /> l l l � l�l\� �j � ���5'" � <br /> DESCL�� LOT NO. 1�/ BLOCK_ TRACT \ ����,� - ��`; �,����� <br /> I <br /> � — ADORESS ZIP PHONE <br /> OWNER <br /> C,`I� ��-�1' �� `s .\ � c.���V�� ,�,�t.`�11i' 1�� � �'P.���. `\l,� `a� _ <br /> TENANT NAME CONTACT NAME ��,�5� Fa`/� PHONE l��L <br /> N �� �\�C�i��� �3�'Sq`��:�., 4��.�;a31, , ;Q�G�,��I�l�� �� <br /> I CONTP4CTOR ADDRESS �P '�L'\C��LO3)1vLl �� <br /> � i <br /> PHON[ ��'(���. . � GX�. �OlaalOJ _ i <br /> �� <br /> PROPOSED USE OF BUILUMG �Building �Mechanical Addition HEAT SOURCE ��, <br /> PERIdIT Combinalion Plumbing WORK�Alteration �Electric � <br /> S � 1) TYAE Demulition Sign IYPE New Gas � <br /> �� Sprinkler(k ol heeds) RepaldMainl. Olher i <br /> CON7RACT PRICE OF WCRK CITY Or EVERETf LOCAL SALES TAX CODE IS 3105 I <br /> i <br /> I <br /> WORK DESCRIPTION <br /> ������ \��� <br /> �; � � �\���, <br /> PLUMnING MECHANiCAL <br /> NO. TVPE OF FIXTURE OR h tM NO. TYPE UF FIXTURE Of?ITEM <br /> �1 WATERCIOSET (TOILEI) __ A/C-0.�HANf)LINGUhIITS <br /> � BATHTIJB _ FORCED AIR SYSTEMS � <br /> � LAVATORY (WASH BASIN) _ HEAT F'UMP �� <br /> SHOWER UNIT HI=f�TEf1S <br /> I _f_ KlTCHGN SINK& DISPOSAL � CLOTFI�S DRYER '�, <br /> _j_ DISHWP.S'riCR L ��NGf:. HOOD <br /> L�UNDRY TRAY _L WAT[Ii I IEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/S?OVE <br /> URINAL _ �iREPLACEINSERT � <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN = GAS RANG[ I <br /> _ BACKFLOW PREVENTER � GAS PIPING � <br /> SINK (StRVICE.�PAR/MOP/ETCJ EXHAUS7 FAN � <br /> OTHER_ _ OTHER._ _ � <br /> i HEREBY CERITIFY THAT I HnVE READ AND EXAIdWED TNIS�PPUCATION AND Kr;i?yy THE SAME TO BE TRUE AND CORRECT. P.I L II <br /> PROVISIONS OF LAWS A�'D ORIDINACES GOVERNING THIS TYPE OF WORK WILL.BE COMPLIED WITH WHETHEfi SPECIFIE�HEREIN OR <br /> tJOT. 7HE GFANTING OF A PEFiM1T DOES NOT PRESUME TO G�VE AUTHORiiI'TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF COhSTRUCTION. THAI"1 AM AUTHORIZED BY THE <br /> pWtJER O IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE I1ND I COMPLY WITH THE STATE <br /> CONTR TOR LAW 18.27 R�W/ N/�D 296.200 WAC. <br /> ,C..f'` /tr�. "✓_-�C� 1 1�o o � <br /> ISiynalure ol OwnedContractoq.4uthonzed Agent D le ��/z ' <br /> L — - 1 -- f <br />