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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI7E ADDRESS PARCEL TAX I.D.� PERMIT 11 <br /> :� �.14� �3 oro9�oaq <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> CWNER ADDRESS PHONE <br /> S ;m eo�,,- 9�/ 5 �lal� �,E. #� z �� - 3�9 - ln5o S <br /> TENANT NAME I CONTACT NAME PHONE <br /> S{F ; -' �o� -c�r�i- S�e��wn�� S�evP_n� �5 - 319=la'S(3`' <br /> CON RACTOR C W(v�0. ADDR SS � I CONTR.LICENSE 11 <br /> PHONE <br /> �I 2`�- - Cc �3� 5 �-�, . S. -. -t# Z <br /> PROPOSED USE OF 9UILDIN6 �Building n Mechanlcel �Addnbn H AT SOURCE <br /> PERMIT Combinalion � � Plumbing WORK 1 Alteretbn E�ectric <br /> TYPE Demotilion � Sign TYPE New oea <br /> --� !�5 O S 4 Sprinkler RepaiNMelnt. Other <br /> C NTRACT PRICE OF WORK CITY OF EVERETT LOCAL SAlE37pX CODE IS�105 <br /> WORK DESCRIPTION <br /> �< < <br /> PLU IBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> I WATERCLOSET A/C—A/HANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITC�IEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSEFT <br /> DRINKING �OUNTAIN GAS fIREPLACE <br /> FLOOR DRAIN GAS RANOE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTNER <br /> I HEFEBY CERITIFY THAT 1 HAVE REAC AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLlED WITH WHETHER SFECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORIlY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTNER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FO(i WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18,.^7 RCW AND 296200 WAC. <br /> �i � ll/�� �! <br /> i neWre ol nedContractoAAulhonzed Agent ate <br />