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PEF� 11T APPLICATIO t <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRES PARCEL TAX I.D.i PE I M <br /> l-(�U ��i�;IT �E <br /> LEGA I.OT NO. BLOCK TRACT <br /> I DESC. <br /> OWNER ADORESS ZIP PHONE I <br /> � <br /> ITENA'NAME C NTACTNAME ^ PHONE <br /> ���c�� I �-� ��,�t4�-°r �z5 -4��-�ss� <br /> CONTP ACTOR f ADDqESS I ZIP C4N�TR�.LICENSE M <br /> �DVM..��.��b K�� ���-�-;rr�r-� IGt��£'� 1�1�( � /�"��c: AiE `lPz�7�Z /f-�VM�F�1R�?�6 <br /> PHONE / (,�l(r,'�(AJUiC.C(_ <br /> , '1�5 �{��� -�05� <br /> � <br /> � PROPOSED USE OF BUILDING Building f"1 Mechanical Addition IiEAT SOURCE <br /> PEqMIT R�.../ C�ombinalion H Plumbing WORK Alteralion Eleclric <br /> !, TYPE �Jpemolilion LJ Sign 1YPE New � Gas <br /> ( C(J�.�(�4.��7�.� ' ; ,_� I��Sprinkler Repaid�dainl. Other <br /> CONTRACT PRICE OF WORK �; �1�j CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> � WORK DESCRIPTION <br /> � <br /> i <br /> ��vJ�ZL �C lil.'IiC.L��� lAJ �Ul �7�/� �.fJ�' <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—A/fiANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP I <br /> _ SHOWER `�� UNIT HEATERS I <br /> = KITC4EN SINK 3 DISPOSAL ��� CLOTHES DRYER i <br /> DISHWASHER RANGE HOOD i <br /> ' LAUNDRYTRAv WATER HEATER <br /> � CLOTHES WASHER ,, ,l METALFIREPLACFJSTOVE � <br /> URINAI. iY!✓ FIREPIACE INSERT � <br /> DRINKING FOUNTAIN X �"N GAS FIREPLACE I <br /> _ FLOOR DRAIN � ,��./ � GAS RANGE <br /> BACKFLOW PREVENTER �� GAS PIPING I <br /> SINK (SERVICE.�BAR/MOP/ETC.) EXHAUSLFAN <br /> OTHER � OTHER 17PL� �IA,'KCE2� <br /> --I — I <br /> I HEFEBY CERITIFI'THAT I HAVE R[AD ANO EXAh11NED THIS APPLICATlON AN�K.�OW THE SAME TO 9E TRUE AND CORRECT. All �. <br /> t�ROviSiO>JS OF�a1v5 AND ORIDIu�CES GOVERNiNG TNIS tYPE OF�vOFK WIIL BE CO�dPLIED�.vITH WHEiHER SPECIFIED HEFEiN OR <br /> ^l0 i. THE GRANTING OF A PEFi1.11T�OES NOT PRESUAfE TO GIVE AUTHORITY TO VIOUTE OR CA?JCEL THE PFOVISION OF ANY OTHEF � <br /> SiATE OR LOCAL I.AW qEGULATING CONSTFUCTION OR THE PEhlFOR6fANCE OF CONSTRUCTIO�. THAT I FM AUTHORIZED BY THE � <br /> O�VNER OF TH ROPER7Y TO PGRFORht THE\VORK FOR VVHICH APPLICA i ION IS h1ADE AND I COA7PLY WITH THE STATE <br /> CONTFACTO 5 LA 10.27 RCW AND 296.200 W�. <br /> �rc',� ( � lv-rv c%� <br /> Signalure oi Owned .onlractodAuthorized Agent Dale <br /> ( � <br /> ` <br />