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�� <br /> PEHMIT APPLICATIO'N � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � ►`� Ql�l l� ' (i 3� <br /> S1TE ADDRESS PARCEL TAX I.D.N PERMIT M <br /> .21a1 Q �,�r�� 1��11a - c� l <br /> LEGA' LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNEH ADDRESS MT U�/SAh'V ZIP PMONE <br /> c�vs,F,B4 %, L�}N✓�, ' .Z�co .�`-,PD�v�; D.v �d1�� 3�5'�y- �7f3 <br /> TENANTNAME I CONTACTNAM£ PHONE <br /> CO R CTOR ADDRESS ZIP CONTR.LICENSE M <br /> ��'l/Ai� <br /> PHONE <br /> PROPOSED USE OF BUILOING Building D Mechanical Addition NEA7 SOURCE <br /> PERMIT Combinalion U P�umbing WORK Alleration Eler,tric <br /> � //—� TYPE Demolition U Siyn TYPE New R�'j Gas <br /> 1 l ' G-C Sprinkler Repair/Mairn. U Oiher <br /> CONTRACT PRICE OF WORK �S"GGG� �� CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> WORK DESCRIPTION A nO �, ��/i��� r v FF«'F� <br /> f - /� �/S UFF��r- <br /> PLUM8ING MECHANICAL <br /> N0. TYPE OF FIXTURE tlR REM N0. TYPE OF FII(TURE Oq ITEM <br /> _ WATER CLOSET WC—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HCAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ qANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CIOTHES WASHER _ METALFIREPLACE'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 _ OTHER <br /> II1 HEREBY CERITIFY THAT I HAVE REA�AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROV�SIONS OF LJ1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> INOT. THE GRANTING Of A PERMIT DOES NOT PIaFSUM[TO GIVE AUTHORIIY TO VIOIATE OR CANCEL iHE PRUVISION OF ANY OTHEfi <br /> STATE OR LOC4L LAW FEGULATING CONSTFiUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM,1UTHORIZED BY THE <br /> OWNER OP THIS PROPERTY TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> COM' CTORS �8.27 CW AND 296.200 WAC. <br /> '� �`f I f� ��/-!1� <br /> 5� u e Owner/C tractoUAuthonzed Agent Date 1/ <br /> L <br />