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IIr=RMIT APPLICAT��)N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M PERMi7� <br /> Co p3i�7'Ly� <br /> LEGA LOT O. BLOCK TpACT <br /> DESC. <br /> QWNER ADDRESS ZIP PHONE <br /> TENANTNAME I CONTACTNAME PHONE <br /> �oG1�a Tw.ncu,�.�v �v.,�er <br /> CONTHACT�F T ADDRESS ZIP CONTA.LJCENSEII <br /> �bum MCf,l�Luni�Al ,Snt. 1�?3 �Jr1� \hll�y }d,ay. �1. 9$pol flu�ulel'171i3$f� <br /> PNONE <br /> �3$38 9780 <br /> PROPOSEO USE OF BUILDING I Building f"1 Mechanical Addi�ion HEAT SOURCE <br /> PERMIT �R/ Combination F_� Plumbmg WORK R�..../ Allerelion Q Ele:tnc <br /> TYPE u Demolition �� Sign IYPE u New u Ges <br /> l.� Sprinkler L� RepaluMainl U Other <br /> CONTRACT PRICE OF WORK �Jo7 �c 9�r. Q� CfTY OF EVERETT LOCAL SRLES TAIC CODE IS�105 � <br /> WORK DESCRIP710N I <br /> -�u r n'�b h a.�.d .Cv�s�L1t �i w}+nre s o.H.d r1c d� Gas Cw�It+s � <br /> PLUMBING M���� �� MECMANICAL <br /> NO. TVPE OF FlXTURE OR REM OvH��'S NO. TVPE OF FlXTUpE OR ITEM <br /> 5 WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB � -p`�d�m _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) I 'Zonc V�lve. _ HEAT PUMP <br /> _ SHOWER 3-VdCJJVYI OU}'I�}( _ UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CI.OTHES DHYER <br /> DISHWASHER 3-OLO��t+s RANGEHOOD <br /> � LAUNDRY TRAY I ^O Ma��olcl Z WATER HEATER <br /> _ CLOTHES WASHER Z METAL FIREPLACE/STOVE <br /> URINAL �-�ac uom PNmp FIREPLACE INSERT <br /> Z DRINKING FOUNTAIN . GAS FIREPL^.CE <br /> � FLOOH DRAIN GAS qANGE <br /> Z BACKFLOW PREVENTER 1� � TQlul Ov1lt{g G.:S PIPING <br /> SINK (SE.�j VI�CE� /.BA.R/MOP/ETC.) r EXHAUST FAN <br /> � OIHER�T rlk J ` S U _ OTHER <br /> �{oof i�r..n� <br /> - SXS"° �' S - - <br /> II HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT AlL <br /> . PROVISIONS OF LAWS ANO ORIDINACES GOVERNING TNIS NPE OF WORK WILL BE COMPUED WITH WH�NER SPECIFIED HEREIN OR <br /> NOT. 7HE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PFOVISION OF ANY OTHER <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFO(7MANCE OF CONSTFUCTION. THAT I AM AU7HOAIZED BY THE <br /> i OWNEF OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH APPLICATION�S MADE AND I COMPIY 1M19TH TNE STATE <br /> CONTRACTOHS LAW 1827 RCW AND 296.200 WAC. <br /> �; �� j��iitli�_.._ . . 7- ���P� <br /> I ign2lure ol�wner/Coatractor/Authonzed Agenl Date <br />