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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-8857 <br /> SITE ADDRESS PARCEI TAX I.D.ff PERM�T a <br /> � 2� C C�c6? �J-i t S�o`f-OCl6 <br /> LEGA LOT NO. BLOCK 7RACT <br /> OESC. <br /> OWNER ADDHESS ZIP PHONE <br /> ��� �/7� '��ll �v�c�j/-�-�-�i 1v�r" `7��z �/ °l�-f-Z55- 3S`r/ <br /> TENANTNAME CONTACTNAME PHONE <br /> �2ln/IL-�. 17JK- f�J2C� �'X,=�„/,� �>7..f.���_��G � <br /> CONTRACTOR�y.7-S/�,�J-��//Ce J AODRESS ZIP CONTR.LICENSE M <br /> ��/ /���z��T7�z�-�=vC`xt'TT/�y 3sTs'�s�'49oPQ <br /> PHONE _/ Z� .3��,r��(� J /�f/l� <br /> . C.c'C��L✓4 �76�2 <br /> PROPOSED USE OF BUILDING Building �MechaniCal Addition I HEAT SOURCE <br /> PERMIT IR-.1 Combinalion Plumbing WORK R1--( Alteralion Q Electric <br /> �L�"'j"��7L_ I TYPE �.�j Demolilion Sign IYPE �j New �] Gas <br /> L� Sprinkler U Reoair/Maint. L� Olher <br /> CONTRACT PRICE OF WORK �a.o�g;,_ CITY OF EVEHETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION ��S�Qu V/✓C 3�X� / ����� S �GN <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF PI%TUFE OR ITEM <br /> WATER CLOSET NC–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 RANGE HOOD <br /> Lf�UNORY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINA� FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOF DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HERE�Y CERIti�HAT I HAVE READ AND EXAM11 W[D THIS APPIICATIOIJ AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS O'�LAWS AtJD ORIDINACES GOVERNING THIS TYPE OF WO(iK WILL B[COMPLIED WITH WfiE7HEfl SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMI7 DOES NOT PR[SUME TO GIVE AUTHORIIY TO V�OIATE OR CANCEL THE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BV THE <br /> OWNEF OF THIS PROPEIiTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT�JRS LAYJ 78�7 RCW AND 296200 WAC. — ' <br /> I <br /> � ���,/ r n. c���i/s�1 <br /> Signature f wnedConlracloqAuthorized Agent / at� <br /> �/�(� ��T ���/ <br />