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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 /,���Z ��4� <br /> � <br /> SITE ADORESS PARCEL TAX I.D.8 PERMIT M <br /> .3/Z.5 Z -a� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADOR:SS 'LIP PHONE <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ���� ADDRESS ZIP CONTR.UCENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING BUilding I") MBChaniCal Addilian HEAT SOURCE <br /> PERMI7 Comhination K Plumbing WORK RLI A�lerallo� [� Electric <br /> TYPE Demolllion LJ Sign TYPE �j New u Gas <br /> Sprinkler U Repair/Maint. U Olher <br /> CONTRACT PRICE OF WORK ` �DD — CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> �c/ <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FU(TURE OR REM NO. TYPE OF FIXTURE OR REM <br /> _ WATER CLOSET _ A/C—AIFIANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK d DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS FiANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> = OTHER = OTHER��� <br /> -,�1�/y <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW TFIE SAME TO BE TRUE AND COPRECT. ALL <br /> PROVISIONS OF U1WS AND ORIDINACES GCVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHEF <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OF THE PEAFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CO T ACTORS 18.27 RCW . 00 WAC. <br /> L- �- <br /> ture ot ne� o ractor ulhorized Agent Date <br />