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( <br /> PERMIT APPLICA�"TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, �VA 982Q1 <br /> 425-257-8810- FAX 425-257-SB57 <br /> SITE ADD ESS�\J . �A EL TAX I.D. #. �� p MIT s � <br /> ��� �� - 1���� S�r .� , ��\ � � � ol- z� <br /> LEGA LOT N0.11 BL CK TIRACT <br /> DESC. � � l—TJ c7(/��1� �J�(�t, E i��+ <br /> OWNER AODRE�S ZIP PHONE <br /> Ca-�> l,fLcCl�, ��1L • , I �lfo ��� ,,ve� ��.ia�,f�r�ny � SinN�Quo, l,� R. �1Qj2-9L <br /> TENAIJT NAME CONTACT NAME /4LS\ r,r. PHONE GCZt� <br /> � � I <br /> N/!a OP �c(a2rB6cC 3av- 59;s 33w-s93� , �3o -��(z� <br /> CONTRACTOR pDDRESS ZIP CONTR.LICENSEM <br /> PHONE � {,�...� . . C.G�nG l �F 036 �✓�� : <br /> _ C7C(� /J/Z2�03 <br /> PROPOSED USE OF 9UILDING Building Mechanical Addition I HEAT SOURCE , � <br /> PERMIT � Combination � Plumbing WORK � Alteratlon � Eiectric <br /> TYPE Demolition Sign TYPE New I Gas <br /> 6 0 �� o Sprinkler(a of heads) Hepalr/Malnt. �.� Olher � <br /> CONTRACT PRICE OF WCRK CITY OF EVERETT LOCAL SALES TA%CODc IS 3105 <br /> WORK DESCRIPTIO!� � <br /> (� ��,� I Z. 23 <br /> [ijAS�� � I 9 �J <br /> PLUMBING MECHANICAL - <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPf:ttF FIXTURE OR I�EM <br /> 3_ WATER CLOSET(TOILET) A!C–A,'hIANDLWG UNffS �--� � I� <br /> 1.� BATHTUB FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) _ HEAT I'UMP <br /> SHOWER UNIT HEATERS I <br /> � KITCHEN SINK G DISPOSAL CLOTHES DRYER <br /> � DISHW�SH[R RANGE HOOD <br /> LAUNDRYTRAY � WATER NEATER ' <br /> I <br /> � CLOTHES WASHER _ ME"tAL FIREPLACE/STOVE <br /> _ URINAL _ FIRcPfACc INSERT <br /> _ DRINKING FOUNTAIN GAS FIR[PLACE <br /> _ FLOOR DRAIN � GAS R4NGE <br /> _ BACKFLOW PREVENT[R � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN n <br /> _ OTHER _ OTHER ��j <br /> _ _ _ ��,0 <br /> - L� <br /> I fiERE�Y CERITIFY ThIAT I H�VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> f'fiOVI510NS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COPAPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN1�itIG OF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ST�TE OR LOCAL LAW REGUI.ATING CONSTRUCTION OR THE PERFORMANCE OF CON;;TFlUCTION. THAT 1 AA1 AUTHOfiRED 0Y THE <br /> OWNER TFIIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE.4ND I COMPLV WiTH THE STATE <br /> CONT CT RS LAW_1827 RC AI�D 2 6.200 WAC. <br /> . Jtilr i�•���� i �i�o�03 <br /> Siynalure of OwnedContractor/Auih�ived AgeN Date i/L � <br />