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P��RMIT APPLICATILN --� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 982C1 <br /> 425-257-8810—FAX 425-257-8857 <br /> SITE ADDFESS PARCEL TAX I.O,k P RMiT• I <br /> Z9 as- R��k�� ,4�� - f <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � <br /> OWNER ADDRESS ZIP PHONE j <br /> �i-o1.��5 �ryM Z� Oz Wcl- h,o,e. �f v� �ve�r•(f G.�4 9s2o1 <br /> TENANTNAME CONTACTNAME PHONE <br /> 4or.P s GyM I S��„� P�o�� y:s »6- s�as� <br /> CONTRACTOR �rr. /V�cn� � o ADDRESS LP CONTR.LICENSE 1 <br /> � /?o. /3w� 5269 ,at�iy NGO 77cM <br /> PHONE LyNN {�ocu� [v{ $�Yo�(( / <br /> 4� ��6-Ss3s <br /> PROPOSED USE OF BUILDING Building �echanicel Additbn I HEAT SOURCE <br /> � PERMR R Combination Plumbing WORK R Allaratlon n Electric <br /> �r� TYPE g Demolilian Sign 71'PE �'IOew ❑ Osa <br /> Sprinkler � Repeir/Main�. D Opiar <br /> CONTRACT PRiCE OF WORK y 4, r o o �� CRY OF EVERETT LOCAL SALES TA%CODE IS 7106 <br /> WORKDESCRIPTION jNS�AL[. (!) Scf OF �»�v c�fh�.� L.� Ff�-S � C�� S�y�M C4S:,�(- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF flXTURE OR ITEM N0. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A/C-A/FiANDI.ING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATEFiS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTNES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> � _ BACKFLOW PREVENTER _ GAS PIPING <br /> , _ SINK(SEFiVICE/BARlMOP/ETC.) _ EXHAUST FAN <br /> I OTHER _ OTHER <br /> I <br /> � — — <br /> ( — <br /> � I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> ; PROVISIONS OF LAWS AND OFIDINACES GOVERNING TH�S TYAE OF WORK WILL BE COMPLIED WITH WMtTHEA SPECIf1E0 HEREIN OR <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PfiOVISION OF ANY OTMEF <br /> � STATE OR IOCAI LAW REGUtATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT I AM AUT110RIZED BY THE <br /> 'I OWNER OF THIS P PERTY TO PERFORM THE WORN FOR WHICH APPUCATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONTRACTORS 18.2 W A / WAC. <br /> �i �`1 4� o y <br /> Sig re ol Owner/Contractor/Authonzed AgeN , ate ��a <br />