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r � . <br /> PERMIT APPLICATIO�I <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.A PERMIT q <br /> �f�� ,C'�A�w�- D /lb - bo� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS PHONE <br /> c-;�.r.��.0 />/'�i����-`� J/Xs� �3/'��,�,o�it.y �����X-y�'9 <br /> TENANTNAME I CONTACTNAME PHONE <br /> l c[lN/=.� .�/f�'7J= <br /> CONTRACTOR ADDRESS CONTR.LICENSEN <br /> PHONE <br /> PROFOSED USE OF BUILDING Building Mechanical Addi�ion HEAT SOUHCE <br /> PERMIT R CombinaUan R Plumbing WORK B Aiteretba D Eiecuic <br /> TYPE Demolilion p Sign TYPE RNew RGas <br /> Sprinkler LJ Repnir/Maint. V othnr <br /> CON7RACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA)C CODE IS 3105 <br /> WORK DESCRIPTION <br /> /1/l-'r!/ ✓I I'��'/= <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR REM NO. TYPE OF flXTURE OR REM <br /> WATER CLOSET _ A�C-A/FiANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(JVASH BASIN) HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KIT(:HEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER MET/1L fIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <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 OPID�NACES GOVEPNING TH�S 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 OF LOCAL LAW qEGULATIN�CUNS i HUC110N OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 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 /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> <� y� <br /> /C r./;C.�/� �;�-�...r-✓ ��J—`�. —l�� <br /> Sighature ol OwnerlConlractotlAuthorized Agenl Dale <br />