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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> _ q 1 -3-0? <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> I SCJ r�° E- �jcC� - 0 z <br /> LE AL LOT NO. BLOCK TRACT <br /> DESC. 3 '7)1* <br /> OWNER ; ADDRESS PHONE <br /> i ,-1-;:- .I N r t1&-e 1-10J .: Ere_ ��(:.> ..j0,1( "?...455- ={-2-'_, _ Z. -9 ---ex-,-,6.,. <br /> Stie-e—-11 r+J4- 1jZ.C3 <br /> TENANT NAME CONTACT NAME PHONE <br /> #`17 <br /> CONTRACTOR I ADDRESS CONTR. LICENSE# <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT it Combination Plumbing WORK Alteration Electric <br /> G ,c.,?-:-..,_, f_,-- TYPE • Demolition Sign TYPE New Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK (J G'�- CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> i ,-1 CQ€(.i sie,.s (7)f==- C".` <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> O _ WATER CLOSET NC-A/HANDLING UNITS <br /> J BATHTUB FORCED AIR SYSTEMS <br /> a LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> I II KITCHEN SINK & DISPOSAL I CLOTHES DRYER <br /> I DISHWASHER I _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> I CLOTHES WASHER METAL FIREPLACE/STOVE J C <br /> URINAL FIREPLACE INSERTL L <br /> DRINKING FOUNTAIN GAS FIREPLACE �f�G �J� G <br /> FLOOR DRAIN GAS RANGE )cti.lOP, <br /> BACKFLOW PREVENTER GAS PIPING r <br /> •�� 9 0,- ,43 <br /> SINK (SERVICE/BAR/MOP/ETC.) "I EXHAUST FAN , I '_/-- v' to X114 U <br /> OTHER OTHER D <br /> — PA 11')0(/ a) <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED 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 OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C RACTjLAWRS LA18.2'7 RCW AND 296.200 WA <br /> �r\ <br /> r� u th i r p lY) - <br /> SiJnaturef Owner/Contracto d Agent <br /> , U ,�� lZ <br />