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i � <br /> i PERMIT APPLICATlON <br /> � CITY OF EVERETT �ERMIY SERVICES <br /> I 3200 CEDAR STREET, EVERETf, V�':- i?E^�1 <br /> � 425-257-6810- F�aX 425-257-885' <br /> 5(TEA�DDP�SS ,\�, PARCE TAXI. t7 Py'�AITh <br /> ����;,�?� �- ��9t" �� . � � C���S��;�C�� ;�J��v0' � C�3�%'l--'.�3 <br /> LEGA LOTNO., BLOCK TRACT <br /> DESC. �' �� C-o c�a���-7�R.•� C�7Ai E� <br /> OWNER ADDRESS ZIP PHONE <br /> G' o�O �zfc:K, � �JC,, , � �I10 j��.ir�t Si'R.�.+ ��5 �/ � F��; , �-�,.iw_��� , wn� yv'7 4 :r <br /> TENANT NAME CONTACT NAME i� `5\ wH� PHONE C L_L` � <br /> / I <br /> f`� A 17n�c �n�Gi[3t.t, „y -s�,35, '� y -5436 , 330-zyzro i <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE N I <br /> PH9t�E C C GD -� L� '!fo3e� l�JG I <br /> � o' `_ ' �xP. ,% O/Z2�f 0� � <br /> PROPG�ED USE OF BUIL�ING Building Mechanica� Addition�� HEAT SOURCE I <br /> S � � PERMIT � COmhination � Plumbing WORK � Alteralion (� Electric i <br /> � � o TYPE Demolition Sign TYPE New � Gas <br /> � Spnnkler(a ol heatls) RepaidPdainL Other <br /> COIJTRACT PRICE OF WCfiK CITY OF cVERETT LOCAL SALES TAX CODE IS 3105 �� <br /> WORK D�SCRIPTION I <br /> (��;,.J 1� �f o I <br /> , <br /> ��= � i � � \ r') �i <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM � <br /> y �VATER CLOSET (TOILET) A/C—A/HANDLING UNITS � I <br /> � BATHTUB � FORCED AIR SYSTEMS I <br /> � LAV�;iORY (WASH BASIN) HEAT PUIJiP � <br /> � _ SHOWER UNIT HEATERS <br /> i � KITCH��' SINK& DISPOSAL I CLOTHES DRYER <br /> � y DISH\NkSHER I nANGE HOOD <br /> LAUNDRY TRAY VJATER HEATER <br /> ' � CLOTHES VJASHER 1�1ETAL FIREPLACE,'STOVE <br /> � _ URINAL FIREPLACE WSERT <br /> DRINKING FOUNTAIN T GAS FIREPLACE � <br /> ! _ B OOR OW PREVENTER � GAS PIPING 3DI fJ I <br /> I _ SINK(SERVICE/BAR/MOP/ETCJ � EXHAUST FAN 1�J.� � <br /> I _ OTHER OTHER <br /> — — _ � <br /> � <br /> II HEREBY CERITIFY THAT I HAVE READ AND 'eXAPdINED THIS APPLICATION AND KNOVl THE SAME TO BE TRUE AND CORRECT. AI.L � <br /> PROVISIOIJS OF LAV'S AND ORI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> NOT. THE GRAtJTING OF A PER611T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLFTE OR CANCEL THE PROVISION OF A�Y OTHER <br /> STFTE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFJRMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE I <br /> OVJNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH APPUCATION IS MADE AND I COtdPLY WITH THE STATE � <br /> CONT RS LA'A'1927 RC A D 296200 VJAC. <br /> /�<. ,' !''d�� �/iv /a� <br /> i SignaWre of OwnedContractodNuthorized Agenl Date � <br /> I/ <br /> L----- <br />