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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-25�-8857 <br /> K o30 3-opQ <br /> SITE ADDRESS PARCEL TAX I.D.0 PERMiT k <br /> � p #� 1rrt5� <br /> LEGA LOiNO. BLOCK THACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> TENANT NAME CONTACT NAME PHONE <br /> U i�m�b �[► I Uf.ron�rn '�r�'r a bl�721n-l�H� <br /> CONTRACTOR AODRCSS ZIP CONTR.LICENSE N <br /> QT�wi�+'G�cr SE2UiGe5 lp�oo I�.�✓e S . q$�o$ 1z1�11�Et'�tP�-- <br /> PHONE <br /> �--�a�- <br /> PROPOSED USE OF BUILDING BuIlding � Mechanlcel I Adtlition HEAT SOURCE <br /> PERMI7 R�..( Combinalion Plumbing WORK Altera�lon R Elactric <br /> TYPE �._j Demolilion Sign TYPE New �J Oas <br /> L) Sprinkler RapaluMeint. L) Other <br /> �;ONTRACT PHICE OF WORK� I MO � C�TV OF EVERET"�OCAL SALES TA%COOE IS 3105 <br /> W <br /> NORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF fl%TURE OH ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> I OATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> I = SHOWER _ UNIT HEATERS <br /> KITCHE�J SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TFAY WATER HEATER <br /> CLOTHES WASHER METAI FIREPLACE/STOVE <br /> � URINAL FIREPLACE INSERT <br /> � DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DFAIN GAS RANGE <br /> � BACKFLOW PREVENTER GAS P�PING <br /> , SINK(SERVICE/BAFL'MOP/ETC.) _ EXHAUST FP.N <br /> OTHER __ _ OTHER <br /> - - ���� <br /> I HEfiEBV CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRU AND COR ECT. �l <br /> PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPIIED WITH WHETH R SPECIFIEDf1EREIN OR <br /> � NOT. THE GRaNTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE P OVISION OF ANY OTHER <br /> S7ATE OR LOCAI lAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12En BY TME <br /> OWNER OF THIS FROPERTY TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> �/fi,nm���,� A�/} <br /> si�e o OwneriConiracto uthorized Agent ate � � <br /> IL <br />