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� <br /> ,w PEI�MIT APPLICATION <br /> . � � . CITY OF EVEREIT PERMIT SERVICES <br /> � <br /> �'���" , �g� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �� �� � � 425457-8810-FAX 425-257-8857 <br /> � /r�.; 1 I -�&cv�� <br /> SITE ADDRESS v� PARCEL TAX I.D.N PERMiT� <br /> - Gj/� '4�e- p01 1 Z-ODS <br /> LE�A LOT NJ�� OLOCK TRACT <br /> DE C. 1 <br /> OWNER ADDRE55 aP PMONE <br /> ���-��2� ��C . (,c���-e,n-t.e,Y� p(6/,{-�,r y f'�tq/�f <br /> TENANT NAME . _ I CONTACT NAME � T `� PHONE <br /> f- / Q. <br /> CONTqACTOR ADDRESS <br /> �`I� �f�Mf �^� � �S � � � I � AP CONTR.UCENSE N <br /> PMONE � ��'T�7 uu..,i.i]' GOI <br /> ��� - 3�-yFyL [.�''''^ LJA -� <br /> PROPOSED USE OF BWLDING Building �MecheniCal Atlditlon MEAT SOURCE <br /> PERMIT g Combinalion Plumbing IWORK Alteration Elettric <br /> TYPE D Demolilion Sign TYPE ew Gas <br /> U Sprinkler Repair/Meinl. Other <br /> CONTRACT PRICE OF WOqK SQ� CITV OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> WORK DF.SC IPT10N <br /> i7� ��Q- r' ✓V1� �n <br /> PIUMBING MECHANICAL <br /> N0. TVPE OF FlXTURE OR fTEM NO. TYPE OF FlXTURE OR fTEM <br /> WATER CLOSET _ A/C—A/HANDI.ING UNITS <br /> _ BATHTUB _ FORCED AIR SVSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATEFS <br /> � KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIqEPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPIACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFI.OW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> 1 HEREBY CER�TIFV THA71 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO COARECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE Of WOPK WIIL BE COMPLIED WITH WNETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMAtJCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAL�E AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> 4/�Z--*-•=�. C,�` /z- !�-�I <br /> Signature of Owner/Contractor/Aulhorized Agen1 ate <br />