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i - , <br /> � P�r�M[T APPLICATIG .J � <br /> ' CITY QF EVERETT PERMIT SERVICES <br /> ; 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810- FAX 425-257-8857 <br /> IS17E ADDRESS PARCEL TAX I.D. M <br /> PEpRMIT♦ <br /> � % � O � � r �a�.1Q—�Q <br /> LEGA LOT NO. BLOCK 7RqCT <br /> DESC. i <br /> OWIJER ADDRESS ZIP PHONE -- <br /> _ SuS �A �� �'' �r. 1 �'��.. <br /> 7ENANTNAME CONTACTNAME <br /> PHONE <br /> �-f �f��.�.,.��'��- �/�s -��s S'l�� <br /> CONTqACTOR �J L �,ti 1_t,� qDDRESS ZIP CONTR.LICENSfl p <br /> T CJ �s�2 3 �� `� �L � <br /> PHONE J,� � �/�� �� r3�PLus�osyP <br /> � PROPOSE USE OF OUILOING Building MechaniCal Adtlition HEAT SOURCE I <br /> � PERMIT Combination R�Q Plumbing WORK g Alteration Q Electnc <br /> 1YPE Dem0lilion U Sign IYpE R New �,,,) Gas <br /> I Sprinkler LJ RepaidMainL U Other <br /> I CONTAACT PHICE OF WORK /�y�„� GTY OF EVERETT�OCAL SALES TAX COOE IS 3105 <br /> (A'/ <br /> WORK DESCRIPT70N <br /> i <br /> _ I(1*CJ C,i� � <br /> PLUMBING� MECHANICAL <br /> � NO. TYPE OF FlXTURE Ofl ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i _ WA7ER CLOSET _ qiC—A/HAIJDLING UNITS I <br /> � BATHTUB _ FORCED AIR SYSTEMS I <br /> , _J_ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> j _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYEF <br /> � _ DISHWASHER _ RANGE HOOD <br /> ; _ �AUNDRY TRAY _ WATEA HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> ' _ URINAL ,_ FIREPLACE INSERT <br /> ,_ DRINKING FOUNTAW _ GAS FIREPLACE <br /> FLOOF DRAIN ,_ GAS FANGE <br /> � BACKFLOW PREVEN7ER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) ,_ EXHAUST FAN <br /> _ OTHEF _ OTHER <br /> I HEFEBY CERITIFY'HAT I HAVE REAO AND EXAfdINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAW$AND ORIDINACES GOVERNING THIS TYPE OF WOPK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A pERM1T DOES 'J07 PRESUPdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY 07HER I <br /> S7ATE OF LOCAL LAW qEGULATING CONSTRUCTION OF.7HE PEFFOFMANCE OF CONSTRUCTIOIJ. THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPEATY TO PERFOPM THE'NOF„FOR'JJHIGH APPLICATION IS tdADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFF LAVJ 18.D�AND 296.200 WAC. <br /> t,�� � l0� ���C� � <br /> Signalure ot OwnevContractcnAuthonzed Agent Date <br />