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� ERMIT APPLICAT�JN <br /> ���„ CITY OF EVEREIT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA g8201 <br /> 425-257-8810—FAX 425-257-8857 <br /> (a,'2 ll-OD <br /> �SITE ADDRESS PARCEL TAX I.D.• <br /> PERMIT M <br /> LEtiA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS <br /> ZIP PMONE <br /> �� � � <br /> wi.w� , <br /> TENAHT Nq1NE COPRACT NAME <br /> _ � . A!�� �i�a;,�� . � o�o,� <br /> ��� �iiYc v� �(�/07M0 <br /> CONTRACTOR ADOqES$ � 21P CONTR.LICENSE I <br /> PHONE <br /> �ZS SS5-/G1�7 2 I � / / „/ � <br /> PROPOSED USE OF BUILqNG Building MecheniCal <br /> PERMIT Addition HEA730URCE <br /> Combination � Plumbing WORK � qlteration I [� Electric <br /> TYPE Demolition Sign TYpE New �] Gas <br /> ��cG� Sprinkler RepaiNMaint. L� Ovier <br /> COMRACT pqICE OF WOqK r.AM � CITy pp EyEqETT�OCAL SALES TAX CODE I$3105 <br /> yOC.V <br /> WORK DESCRIPTON <br /> �i5 3 e.�. �N•�oo..., <br /> PLUMBING � � <br /> MECHANICAL <br /> NO. TYVE OF FlXTUqE OR REM NO. TYPE OF FlXTUqE OR ITEM <br /> , � WATER CLOSET _ A/C—yMqNDLING UNITS <br /> �, BATHTUB _ FORCED AIR SYSTEMS <br /> � �_ LAVATORY(WqSH BASIN) _ HEAT PUMP <br /> i SHOWER _ UNIT HEATERS <br /> l KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER <br /> ' _ LAUNDRY TRAY R�4NGE HOOD <br /> ' _ CLOTHES WASHER �-- WATER HEATER <br /> _ URINAL . _ METAL PIREPLACFJSTOVE <br /> _ DRINKING FOUNTAIN — FIREPLACE INSERT <br /> _ FLOOR DRAIN � _ GAS FIREPLACE <br /> _ BACKFLOW PREVENTER � — GAS RqNrE <br /> SINK(SERVICE/BAR/MOP/ETC.) — GAS PtPING <br /> � OTHER a„� _ EXHAUST FAN <br /> _ OTHER <br /> I <br /> I HEREBY CER171FY THAT I HAVE READ AND EXAMINED TMIS APPLICATION ANO KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROV�SIONS OF LAWS AN�ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN Oq <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OH CANCEI THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L4W qEGUL4TING CONSTRUC710N OR THE PERFORMANCE Of CONSTRUCTION. THAT I AM ASITHORIZED BY THE <br /> OWNER OF THIS PROPERTV 70 PERFORM THE WORK FOF WHICH APPLICATION IS MADE AND I COMP�Y WITH THE STATE � <br /> CONTRACTORS LAW 18.2�RCW AND 298.200 WAC. <br /> Signalure of Owne ontrector/Authonzed A ent 'r � �Z <br /> 9 ate <br />