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P'�RMIT APPLICATII,�V <br /> CITY OF EVERETT PERMIT SEHVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE AODRESS PARCEL TAX I.D.# PERMIT s <br /> 2oly �roa�„ua7 13(�2 C�b <br /> ! /� <br /> LFGA LOT NO. 9LOCK TRACT <br /> DLSC. <br /> OWNER ` r .� ADURESS <br /> ��h v ' " ���"�B N V� 2 O �(u a f p Z¢�,�,,� ZIP PHONE <br /> �j 9'gzoi �Zr —3��- q33z <br /> 7ENANTNAME CONTACTNAME <br /> '' I PHONE <br /> EoEnl t 3dao �..� �. Q�tiw� •� <br /> �ea +� fln r f <br /> CONTRACTOfl • ADDRESS <br /> C�.J� '� �J��^� ZIP CONTR.LICENSE M <br /> PHUNE <br /> PROPOSED USE OF BUILDING 8uilding Mechanical Addilion MEAT SOURCE <br /> PERMIT � Combination R Piumbing WORK � Alteralion Electric <br /> B�S�koyS TYpE Demolition D Sign TYpE New ' Gas <br /> Sprinkler Fepair/Maint. Other <br /> CONTRACTPRICEOFWORKY SGOO � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> (�(C�.J f o o � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUVE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATERCLOSET _ q/C—A/HANDLINGUNITS <br /> _ BATHTUB _ FORCED AIF SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK&DISPOSAI _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATCR HEATER <br /> _ CLOTHES WASHER _, META�FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICEJBAWMOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT 1 HAVE READ AND EXAM�NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUl-HORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTIOP!OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEfl OF THIS PROPERN TO PERFORM THE'NORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> S�gnaWre of OwrerlCoNractodAuthonzed Agent Date <br />