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( <br /> PERPJIIT pPPLiCATION <br /> rITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE',, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> - P�� 3�s- ��� <br /> SITE ADDRESSC��r�� `I�I / I' � I t P<iRCE\TAX I.D j# - �RMI7 p <br /> � _ lU'lry .�) � V�, . �U���i � D.8 <br /> 1 > � . 1 03�- �I,� <br /> LEGA LOT NO. � BLOCK . TRACT r, 'I ��-y� � <br /> OWNER � , � � ��N��.4—�—__l\� `�C. J I <br /> ADDRESS LP PHONE <br /> �O��r-�., ��.c.�`�\�o S���c� 5��������,�,a� , �� ��� �G�� ,w� . � „a�a <br /> TENANT NAME CONTACT NAME��1��1 Fa`� PHONE leL� <br /> �\� ������. C��h�� ;3y���,�_, 9���.�,,�3� �Q � � - <br /> , ��_ , .,,u., , ,� � i <br /> CONTRACTOP A�DRESS —T— z�p ppry7R.L�CENSE M <br /> PHONE���� `-"�uU�O(Zr1,vLl <br /> �xp. l0 a a 03 <br /> PROPOSED USE OF BUILOING I .gn(�Buildinc� Mechanical Addition HEAT SOURCE <br /> S � � PEHMIT '� ) Combination�Plumbing WOPK�Alterution Electric � <br /> � I TYPE n Demolition Sign TYPE New Gas <br /> C Sp�inkl0f(M ol heatls) Repeir/Melnl. Other <br /> CONTRAC'f PRICE OF WORK CITY OF EVERE7T LGCAL SALES TAl(CODE IS 3105 <br /> WOFiK DESC`RIPTION <br /> ���\V \\�� <br /> �>��\ � ���'���� , <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FI7(TURE OR ITFM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLUSEi (TOILET] !UC-A�HANDLING UNITS � <br /> � BATHTlJB _ FORCED AIR SYSTEMS <br /> LAVAI'ORY(WASH B.4SIN) HEAT PUMP <br /> SHUWER UNIT HEATERS I <br /> �_ KITCHEN SINK E DISPOSAL � C�OTHES DRYER <br /> �_ DISIiWASHER � RANGE HOOD <br /> LAUNDRY TRAY � WATER HFATER � <br /> �_ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> .__ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _f__ GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER _ OTHER <br /> {7 <br /> I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TfiE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNItJG THIS TYPE OF WORK WILL BE COMPI.IED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TI1E GRANTI�G OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW qEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OVJNER O IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AMD I COMPLY WITIi THE STATE <br /> WNTR TOR LhW 1827 RCW ND 296200 WAC. <br /> ,�..� /��� 1� I�o% 1 <br /> SignaWre ol OwnadConlradodAuihonzed Agenl p�je`— � <br /> 2 <br /> — � <br />