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� i <br /> P�r2MlT APPLICATI�rI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE A�ESS PARCEL TAX I.D.p PERMiT ri <br /> �J T7 sT. 2 -o o c 1� C� ,�/U- <br /> LEGA L NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> L AMI,�l �lo0 1-�L�i�'�G-s 27/7 ,Q� �er�l�✓' P�-v�'/u� 9�b� N.1s.11��2 <br /> TENANTNAME ONTACTFORPERMIT PHONE <br /> 5�idu,� ��.�f�•� I ,�.c� �1�1�L n�e,l�(� yas- lS z/ 3 r <br /> CONTRACTOR�vE� � L' m fl ADDRESS ,7J:��� �i A r ZIP GQN1t.UCENSE Y � <br /> PHONE y a 5� i5 a� y, y ��e�r <br /> ' �2�� �rFs/J1iE� <br /> , <br /> PROPOSED USE OF BUILUING Building f�MeChaniCal Adtlillon HEAT SOURCE <br /> PERMIT R Combination H Plumbing WORK � Alleration � ElecUic <br /> TYPE D Demolition LJ Sign 7YPE New Gas <br /> �/a� L 5 :4c,e U Sprinkler RepaidMaint. Other <br /> CONTRACT PRICE OF WORK ��/f/JD — CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> vv <br /> WORK DESCRIPTION <br /> ..Z-iU�l.aua /•o,Z�- �ur � f T /�v.A.L c/•u��s 3c �c� sys P�S <br /> y �x/�.sT �FA.Us �duc�«-�-rr , P l��t-�/ L�'�s P���:�'G' <br /> PLUMBlNG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> LAVA70RY(WASH BASIN) HEAT PUMP <br /> StiOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHFR METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRiNKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING � � U/��l S <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMIN[D ThIIS APPLICATION AND KNOW THE SAME TO BE TRUc AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMil DOES NOT?RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF TNIS PROPERTY TO RFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO TRACTORS LAW 1827 RCW A D 296.200 WFC. <br /> 1 <br /> � ��'Z� �O � � <br /> ignature of Owner/ContractodAutho ' ed Agent Date � <br /> DEBIT 8 CREDI7 CARDS ARE NOT RCCEPTED <br />