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�— P�:r�MIT APPLICATIG.J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-9857 <br /> �c Ua�3-r.�� <br /> SITE ADD SS{� " PARCEL TAX I.D.N PERMi7 M <br /> 2 q`0� 1W 4� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESr•1 _ <br /> NER ADURESS LP PHONE <br /> �c��D �G�€�- QZI�O �—`N l� R8 l�'1 206�833a3 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTHACTOR ��,(1DpRE� `, ,ry M �ZIp �) CONTR.UCENSE� <br /> �J oL�� �LU V��\1J6 z� �a�.�,��� ��«�•r <br /> P EO S b � r+1wCT" "��p� -ISZ-IO <br /> PROPOSED USE OF BUILDING Building f1 Mechanical Addition MEAT SOURCE <br /> /'� 1 ���\�� PERMI7 R Combinetion ��Plumbing WORK � Alleration �Elactnc <br /> \I 1 TYPE Demolition V Sign TYPE New Oae <br /> ] Spnnkler Repairn.teim. Other <br /> CONTRACT PRICE OF WORK .�'�O �lO� CRV OF EVERETT LOCAL SALES TAX CODE IS 7106 <br /> WORK DESCRIPTON <br /> U'PQI�\� l� K� �U.)�Q �1 � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF fl1(TUHE OR ITEM <br /> WATER CLOSET A/C-NFiANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HFATERS <br /> I KITCHEN SINK 8 DISPOSAL _ CLOTNES DRYER <br /> � OISHWASHER FANC�E HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER META!FIREPLACEiSTOVE <br /> URINAL _ �IRE!�LACE INSERT <br /> DRINKINC,FOUNTAIN _ GAS FIREPI.ACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> � SINK(SERVICE/BAR/MOF/ETC.) _ EXHAUST FAN <br /> OTHEF _ OTHER <br /> — I — — <br /> I HEREB'f CERITIFY THAT I HAVE READ AND EXAMINED TMIS APPUCATION AND KNOW THE SAME TO 8E TRUE ANO CORREC f. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING TH�S NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO YIOLATE OR CANCEL THE PR()VISION OF ANV OTHER <br /> ST E OR LOCAL LAW FEGUTATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT 1 AMl�UTHORIZED BV TME <br /> IO N OF THIS PROPER TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH fME STATE <br /> C NT AC OR$LA 1� W AND 6.200 WAC. _ <br /> � Signalure ol Owner/Coniraclor/Authorized Agenl te <br /> x oao`� - ��o� <br />