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P MIT APPLICATIO�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> �,B//2 D/� <br /> , <br /> SITE ADD7RES_S ��/ PARCEL TAX I.D.M PE �/Z �QJ 2 <br /> G �, <br /> LEGA LOT NO. BLOCK TRACT . <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE M <br /> PHONE �(�(i/�^r''-� <br /> PROPOSE�USE OF BUILDING f� Building Mechanical Addition I HEAT SOURCE <br /> PERMIT K Combinalion RI--( Plumbing WORK Alteration � Electric <br /> TYPE �...1 Demolilion U Sign TYPE New Gas <br /> LJ Sprinkler RepaidMaint. Olher <br /> CONTRACT PRICE OF WORK .CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF flXTURE OR REM <br /> WATERCLOSET _ A/C-A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATOFY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGEHOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METALFIREPLACE/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 /> lY' — <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPECT. ALL <br /> PROVISIONS OF lAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED W�TH WHETHER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OH LOCAI.LAW REGUTATING ONSTi7UCTI0N OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPERN RFORM THE WORK FOFi WHICH APPLICATION IS MADE AND 1 COMPIY WITH THE STATE <br /> CONTRACTORS W 18 CW AND 296200 WAC. <br /> � <br /> 2-io - I <br /> Signatu e of n r/Cont todAulhorized Agent Dale <br />� <br />