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P�.�RMIT APPLICATI�,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADORESS ' 2G,�S LOEI f � ' pARCEL TAX I.D.A P IT a <br /> ����� - ��- 9 ��,v� v2lJ�-�7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER �,��,�p �y f��r-��/�,v� ADDRESS ZIP PHONE <br /> ��-�--���� �� z��s ����hy ,�� � y2o, Nif- 3!2-�49% <br /> TENANTNAME CONTACTNAME PHONE <br /> T��i Sc���l-�'� s Gv�/'�v� C�2�`�,�����v�� c� i,� >�2-��' �'� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING Building n Mechanical Additlon HEAT SOURCE <br /> PERMIT B COmbinalion H Plum6iny WORK Alteralion � Eiectric <br /> TYPE D Demolilion LJ Sign 1YPE New Ges <br /> U Sprinkler Rapair/Meinl. O�her <br /> CONTRACT PRICE OF WORK /]/Lt` �Lj��� ,e� CITY OP EVERETT LOCAL SALES TA%CODE IS 3105 <br /> �/�. <br /> WORK DESCRIPTION <br /> `Z"v (�e 11- i.c,fz/� l-��'¢� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI)(TURE Oq ITEM NO. TYPE OF fl7(TURE OR ITEM <br /> WATER CLOSET A/C—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTF.MS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KI?CHEN SINK S DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY W�TER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIR[PLACE <br /> FLOOP DRAIN GAS RANGE <br /> I _ BACKFLOW PREVENTER _ GAS PIPING <br /> � SINK (SEHVICE/BAFVMOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> � — — — <br /> I1 HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KtJOW l"HE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L�1W5 AND ORIDINACES GOVERNING THIS iYPE OF WORN WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. TfiE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO'JIOLATE UR CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE CR LOCAL LAW REGUTATING CONSTPUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OFTHIS PROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS h1PDEl�ND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> I <br /> Zdc _ �— U,Q. <br /> Signature of Owner/C zed Agent Date /,7�� <br /> � � <br />