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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 /> SITE ADDRESS PARCEL TAX I.D.N PERAl1T M <br /> � � 2 a� Po3oroa� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> �W p ADDRESS ZIP PMONE <br /> �O� <br /> TENANTNAME CONTACTNAME PHONE <br /> �uGLQt.��[_eo �� I ; <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M ' <br /> PHONE (/(N!/V✓ <br /> PROPOSED USE OF BUILDING n Building Mechanica� Atlditlon HEAT SOURCE I <br /> PERMIT �—� Combinatlan R Plumbing WORK � Alleretlon n Electric � <br /> TYPE �,_� Demolllion p s�gn TYPE New g �BB <br /> LJ Sprinkler(w ol heada) Repali/Malnt. Other <br /> I <br /> CONTRACT PRICE OF WORK CITV OF EVEHETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> � <br /> i <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) 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 _ RANOE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> � URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> __ FLOOR DPAIN (3A5 RANGE <br /> _ BACKFLOW FREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> __ OTHER _ OTHER <br /> II HEt7E�V CERITIFY THAT I HAVE FiEAO AND EXAMINED THIS APPLICATION AND KNUW THE SAME TO BE TRUE AND WHRECT. ALL <br /> PROVISIOIJS OF LAWS AhD ORIDINACES GOVERNING THIS TVPE OF WORK 1Y�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIIJG OF A PER1dIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOC GU G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE$6FT 5 P O PE RM THE WORK FOR WHICH APPLICATION IS IAADE AND I COMPLV WITH THE STATE <br /> CONYRACT R�S �1/,8: RCVJ .200 WAC. <br /> ,�; ��- /-2 y� 3 <br /> na ura wner/Coniracl r Authorizod gent e�e <br /> l_�------� -------- — <br />