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P�MIT APPLICATIO <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX l.D.k PE IT k <br /> .�..4 � I (��ua '� <br /> LEGA LOTNO. BLOCK TflACT <br /> DESC. <br /> OWNER ADORESS 21P PHONE <br /> ItV (',z�P�s�l`r� 3�t�� 13QOAowa�/ a�� # - <br /> TENANTNAME I CONTACTN ME PHONE <br /> TExa6o�'xaQ.c.�s5 ut3C 5c�eev ,DA�z�c.� ya-5-7�w-88� l <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> v�ymp�� /1t�c.NANlcI{L Pv. �3uY 53�-� LyNN�✓o°�ju�4 9fv�L O�ympmr�7ov/ <br /> PHONE <br /> tias-�7�1 �88�f1 <br /> PROPOSED USE OF BUILDING 17 Building f'�} Mechanical Addition MEAT SOURCE <br /> PERMIT K Combination F_� Plumbing WORK � Alteration � Electric <br /> TYPE �..,� Demolition L� Sign TVPE New Gas <br /> �-K;'RG'SS Lui3�r U Sprinkler RepainMaim. Omer <br /> CONTRACT PRI�E OF WORK ��!O�v v� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ,��Q� �� <br /> PLUMBING MECHANICAL <br /> �O. TYPE OF FIXTURE OR REM N0. TYPE OP flXTURE OR ITEM <br /> WATER CLOSET � A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPI.ACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTEfl �. GAS PIPING <br /> SINK(SERVICE/BP.R/MOP/ETC.) �,_ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERII�IFY THAT I HAVE READ AND EXAMINED THIS APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE 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 PROV�SION OF ANY OTHER <br /> STATE OR IOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT TORS LAW 18.27 RCW AND 296200 WAC. <br /> ' 11 a-v � <br /> Sign re ol Ow r/Conlracto uthorized Agent Date l/ <br /> L <br />