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t cRMIT APPLICAT.`"�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI7E ADDRESS <br /> G�/� PARCEL TAX I.D.N PERMIT p <br /> O� <br /> LEGA LOT N0. BLOCK THACT <br /> �ESC. <br /> OWNER ADDRESS <br /> / -�� �_! AP PHONE <br /> L�I.If�3% YT�4'/a-i�lG Ge�G!//6 �/'�1����� / <br /> TENANiNAME I CONTACTNAME <br /> PHONE <br /> CONTRACTOR�Q�,� � `Le_T� qDDRESS LP CONTp.UCENSEM <br /> ��- �. , Ti �-� /O Ef�+��!'c� y�/ L <br /> PMONE /�7 /"'� / -�/ IO '/ � �� �' w/ O CI�l Q-O 16��� <br /> 9� � � <br /> PROPOSED USE OF BUILDING Building Mechanical <br /> � PERMIT Addilion HEATSOURCE <br /> S Combination Nlumbing WORK Allerallon � Eiectric <br /> TYPE Demolilion Sign TYPE � New <br /> Sprinkler Gas <br /> Repair/Maint. Olher <br /> CONTqACT PRICE OF WOq�( r'7 / <br /> /^ IG�d CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION �S � � <br /> 9 � /� ✓ /a-�r � � �,uc�-Ee� \-\�e c� <br /> � -�.��v�r�e.. �� (Jl��w.c�eS <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FlXTURE OR ITEM <br /> NO. TYpE OF FlXTUHE OR�TEM <br /> _ WATER CLOSET <br /> _ BATHTUB — aC-A/HANDLING UNITS <br /> _ LAVATORY(WASH BASIN) — FORCED AIR SYSTEMS <br /> I _ SHOWER _. HEAT PUMP <br /> _ KITCHEN SINK& DISPOSAL — UNIT HEATERS <br /> _ DISHWASHER CLOTHES DFYER <br /> _ LAUNDRY TRAY RANGE HOOD <br /> I _ CLOTHES WASHER T �VATER HEATER <br /> _ URINAL _ METAL FIREPLACE/STOVE <br /> I — DRINKING FOUNTAIN PIREPLACE INSERT <br /> � _ FLCUR DRAIN GAS FIREPLACE <br /> I _ BACKFLOW PREVEN7ER GAS RANGE <br /> _ SINK(SERVICE/BAR/MOP/ETC.) �AS PIPING <br /> _ OTHER — EXHAUSTFAN <br /> ' _ OTHER�_ <br /> I HEFEBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7A7E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONS7RUC710N. THAT I AM AUTNORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AtJD�COMPLY WITH THE STATE <br /> CON7C RAC�qS LA t8.2 CiN AND 296.200 WAC. <br /> S� <br /> S�gnawre o�uwner/ConlractoUAuthonzed Agent /����� <br /> Date <br /> VY10,� - 3 7 <br /> r <br />