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P��RMIT APPLICATIG�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDFiESS PARCEL TAX I.D.N � PERMI7 M <br /> �o23a2 h'roQ,� $ oZo�l -o��o <br /> ESC. LOT�� � ��0 3 � ncr (,e-. 1� <br /> AAP <br /> OWNER ADORE53 ZIP PMONE <br /> �a.S- as�. �as <br /> 5`�a nl r�c�e, 3�.3 z B r 6 a:a9 d�la �v- �8a.o) - <br /> 7ENANT NAME COi 1TACT NAME PHONE <br /> �aU �o� <br /> CONTRACTOR ADDRESS LP CONTR.LICENSEI <br /> PHONC <br /> PHOPOSED USE OF BUILDING Building � Mechanicel Addition HEAT SOURCE �� <br /> PERMIT B Combinelion Plumbing WORK R Alteralion (7 Etectric �I <br /> TYPE D Derholition Sign TYPE D New D Gas � <br /> U Sprinkler � Repair/Meint. D Other <br /> CONTRACT PRICE OF WORK GTY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORKDESCRIPTION ���u�. �`TW rJON -GM� �� �iuiF���IOMs <br /> PLU�IBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR ITEM N0. TYPE OF 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 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPIACE/STOVE <br /> URINAL _ FIREPL4CE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRA�N _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> i = SINK (SERVICUBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I — — <br /> II Y.EP.EBY CERITIFY THAT I HAVE READ AND ERAMINED THIS APPUCA710N ANO KNOW THE SAME TO 8E T!7UE AND CORRECT. ALL <br /> PROVIS�ONS OF IAWS AND ORIDINACES GOVERNING TH�S TYPE OF��'�RK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> INOT. THE,RAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE PUl NO��,TY Tp VIOUITE OF CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUUITING CONSTRUCTION OR THE PERFORM�'�ICE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br /> � OWNER OF TiIS PROPEFTI'TJd EflFORM THE WORK FOR WHICH.iPPIIG�TION IS MADE AND i COMPLY WITH THE STATE <br /> CONTRACTJRS�27�ND 296.200 WAC. r � <br /> �L i^^�/ �� V� <br /> � <br /> Signalure a�er/ContiactodAuthonzed Agent ate <br /> r <br />