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� � <br /> PERMIT APPLICATION <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> S�TE ADDRESS PARCEL TAX I.D.N /w�EH��'�� Q) � <br /> �J�,'L CCI.� ��Vu1L CX� / .� GY�� C�l O[7 i� <br /> LEGA LOT N0. BLOCI: TRACT <br /> DESC. �1� �1ity�?fr�'L� 3 , — <br /> OWNER ADDRE85 ZIP PHONE <br /> RPo'��A fl?U-}Mcac- �d'�Pc=*tN's 72b 13`�'i� '�T•z��'�T'e �� Z� 29?•GZa� <br /> �„�tt�wn ���f � � <br /> TENANTNAME <br /> CONTACTNAME PMONE <br /> (��„��b"'�c�r... Zltit/�i,nxs ��Pl-Iht-A1Zu�'+i� ZoG�4G'1• vt�l3 <br /> vt <br /> '„Lwv fl- c'r�- "`- <br /> CONTRACTQR ADDRESS 21P CONTR.LICENSE N <br /> ,qt-✓�ILlu�i �/�`'f+oGt/�f�SS Ily,lG` d10 ?/(r��l} �71.51t f}L-Of�-IAX'?oi. �.( <br /> PHQNE j�iN��+-,� q9v21-93q7 <br /> ttv;/'E$�• 1313 <br /> PROPOSED USE OF BUILDIN6 � 6uilding D Machanical Addition HEAT SOURCE <br /> ������ PERYIIT Com6lnetion U Plumbing WOHK �Alleretion � Elaclric <br /> I TYpE Demolilion U 5�9� TYPE NeW 6es <br /> Sprinkler Repalr/Melnl. Oiher <br /> CONTRACT FRICE OF WORK #1dG�� CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCP'.PTION ^ �F�� � � 3 /y�pYa <br /> "� a�tft+1 IN��'f�� �' N+�OhUA: 17�/a[M-+a.'f1c.Ivt+/bGf/� �' �✓-o �L���ltl9'J ILu <br /> (t.�..�s� CI��`'t� 2 �3� � T'kZ l�u�uai►x., <br /> ' PLUMBIPlG MECHANICAL <br /> N0. TYPE OF FI%TUHE 4R ITEM N0. TYPE OF FIXTURE OR ITEM — <br /> WATER CLOS[T A/C–AlHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(VJASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEAT[RS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHW�SHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN __ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREV[NTER _ GAS PIPING <br /> SINK(SERVICE/HARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I NEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO OE TRUE AND CORHECT. ALL <br /> PRO`JISIONS OF LAWS�ND OR�DINACES GOVERNINC THIS TYPE OF WORK WILL 8E COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. TI1E GRANTING OF h PERMIT DOES NOT PFiESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PPOVIS�ON OF ANY OTNER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF 1-HIS PROPEflTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO R OFi LAW 18.27 RCW AND 296200 WAC. <br /> � �Z�4IU1 <br /> Si ature o�OwnedConlraclor/Aulhbrize�Agenl a� <br />