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3 <br /> t <br /> P MIT APPLICATION � <br /> � <br /> CITY OF �VERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 § <br /> 7 <br /> SITE ADDRESS PARCEL TAI(I.D.� PERMIT N ,� <br /> 2 /Qi� (� -D�� 1 <br /> LEGAL LOT NO. ��LOlCK TRACT `� <br /> DESC. Bq�DI I �1.� <br /> WNER ADORESS PHONE <br /> `�u¢� � <br /> TENANT NAME I CONTACT NAME l�,�0��� <br /> 'T-�r�� �•� <br /> sT�►/�T TIT�-� G�1, o � <br /> CONT_ RACT�R� ADD E CONTR.LICENSE• <br /> ,�-z5 �� �-� a.�r> .�R s�-to�K <br /> r <br /> PHONE IVI���-�IU�/ �QJ•Li�U <br /> PROPOSED USE OF BUILDING gBuilding DMechanical Additbn HEAT SOURCE <br /> ��� PF:HMIT "[� Combination QPlumbing WORK AltareGon D'Electric <br /> �ypE l,1 Demolition U Sign TYPE RepsiNMaint UJ OMer <br /> L� Sprinkler <br /> CONTRACT PRICE OF WORK �.j{-] QQQ CITY OF EVERETT LOCAL SALES TAX CODE�S 3105 <br /> WORKDESCRIPTION �j—' �' tj�I�,I�'-'' Gl�R 1- � / ��1����� <br /> � <br /> W�� , <br /> �l UMBING MECHANICAL <br /> ryp, TYPE OF flXTURE OR ITEM NO• TYPE OF FlXTUNE OR fTEM <br /> WATERCLOSET _ A/C-A/HANDlINOUNITS � <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES 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(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I NAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TAUE AND COHRECT. ALL <br /> PROVISIONS OF IAWS AND OFIDINACES GOVERNING THIS TYPE OF WOflK WILL BE COMPLIED WITH WHETHER SPECIFIED HE�:EIN OR <br /> NOT. T G ANTING OP A PERMIT DOES NOT PRESUIdE TO GIVE AUTHORITY TO VIOUTE OR CANCFL THE PROVISION OF ANY OTHER <br /> STATE R AIr.LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZFD BY THE <br /> OWN O IS OPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TNE S?ATE <br /> CONT A 27 RCW AND 296200 WAC• <br /> I <br /> , D <br /> Signat of OwnedContradodAuthodzed Agent Date <br />