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� cRMIT APPLICATI�IN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 <br /> SITE ADDRE3S PARCEL TAY.I.D.N PERMiT x <br /> /4��i �����; ��� I 1� oac�-oo`� <br /> LEGA LOT NU. BLOCK TRACT <br /> DESC. <br /> OWNEH ADURESS :IP PHONE <br /> J/-1m � s � l�A � -•u� � (� iY i.l�•� •:� 9✓1�� •lz,- tc7- 9GTY <br /> TENANTNAME I CONTACTNAME PYONE <br /> S,7 M-� s'A �'^�` VO S'�/N �2 �' ]Y Y-.'v S / <br /> / <br /> CONTRACTOR ADDRESS LP COPRR.LICENSF.M <br /> PHONE <br /> PROPO�ED USE OF BUILDING I f'1 Building I� Mechanical Addi�ion HEAT SOURCE <br /> PERMIT bK�( Combinetion �_� Plumbing WORK . "+ra�ion [w7� Electnc <br /> - TYPE Q�] Demolilion U Sign IYPE New �,j Gas <br /> ��s��+��� L> Sprinkler Repelr/Meint. U 01her <br /> CONTRACT PPICE OF WORK CITY OF EVFREIT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION q n / /1 <br /> R�/ tw.or� S � ml E,.�Ja,!.._'� 11 ..� �Wi:.l U•� [..�Jr Jre/2 oL C+i <br /> /�-a w..i�� /�//F^'< / � � u(L ��iy..r o� �iairy. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> WATEF CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEHT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PiPING <br /> SINK(SERVICE/DAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHEA <br /> I -- — <br /> i - – -- <br /> � I HEREBY CERIiI(-'V THAT I HAVF 9FAD AND E:lAMINED TMIS APPLICATION AND KNOW THE CiAME TO BE TRUE AND CORRECT. ALL i <br /> I PROVISIONS OF L4WS AND OFIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHEfHEA SPECIFIED HEREIN OR � <br /> � P�CT. THE GRANTING OF A PERMIT DOES��OT PFESUME TO GIVE AUTHORITY TO VIULATE OR CANCEL THE PROVISION OF ANY OTHER �. <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUGTION. THAT I qM AUTHORIZED BV TM[ ( <br /> I O\VNER OF THy�PfiOPERTY TC PERFOFM THE WOHK FOR WHICH APPLICATIUN IS MADE AND I COMPLY WITH THE STATE <br /> ' CONTRACT04S LiW 1827 R � ANC 296.200 WAC. <br /> 7 1� ��%'�. 1 - z � � .� i <br /> ; Si ature vmenCon!ractor/Authonzed Agent ate I <br /> DEBIT & CREDII' CARDS ARE NOT ACCEPTED <br />