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�ERMIT APPLICA�'JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �� � -(j�s <br /> 425-257-8810 - FAX 425-257-8857 �'`"� <br /> � Q� ��� ��. <br /> SITE ADDRESS ���y � �r ��� PARCEL TAX I.D.� PERMIT M <br /> t� '}'�' 41�.. - 7�G "O�Z._.- <br /> LEGA LOTNO. BLOCK TRACT <br /> UESC. i 7 <br /> OWNER AODRESS ZIP PHONE <br /> �wa� ���,P �/o sZZs A���� �;���� s:�.�. uT 9s�,� � <br /> AM�MTMAYIE � qyav� T��.nv�Y,r I CONTACTNAME PHONE <br /> �L Q�P. <br /> CONTRACTOR � ADDRESS ZIP CONTR.IJCEN5E11 <br /> Tn}ttwesf tewal+�c�+�h=�. 6sI N I�b'!/ Blyd. lE2�j =NTtRt�l2lop <br /> PHONE �`�'75�� },S)y�/�bo_ �L�- SY23 tcll. flF? <br /> PROPOSED USE OF BUILDING Build!ng n Mechanical Addllion HEAT SOURCE <br /> PERMIT Combination H Plumbing WORK IR...[ Altera�lon R Electric <br /> TYPE Demoiltlon IJ Sign TYPE u New `,� Gas <br /> Spnnkler U Repair/MamL U Other <br /> CONTRACT PRICE OF WOHK C�TY OF EVEFiETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION p�,�,�et��it�1 � S'�� �� <br /> I <br /> I <br /> PLUMBING MECHANICAL <br /> NO. +'YPE OF fl%TURE OR ITEM NO. TYPE OF Fl7(TURE OR ITEM <br /> � _ WA'fER CLOSET /UC—A/HANDLING UNITS <br /> I = BATtiTUB = FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WA1ER HEATER <br /> CLOTHES YJASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUN-AIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER_ <br /> 1 HEREBY CE(iITIFY THA71 HAVE READ AND EX:.MINED THIS APPIICATION AND KNOW THE SAtdE 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. Tl1E GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORITY TO�IOLATE OR GANCEL THE PROVISION OF ANY OTHEF <br /> S7ATE UR LOCAI LAW RFGULATING CONSTRUCTION OR TNE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORRED 8Y THE <br /> OWNER O� ERTY TO PE OfiM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR7CTOR''" W 18.27 R W 2962 WAC. <br /> � �fi O <br /> Sign e ol OwnerlCo ractoriAulhanzed Agent Oa e i y <br />