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1 <br /> PEI�MIT 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 YAX I.D.N PENMi7• <br /> �s� co16 , Po�i a-o�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDAESS ZIP PHDNE <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE� <br /> PHONE <br /> PROPOSED USE OF BUILOING Building �chanical D AOdiiion I MEAT SOURCE <br /> PERMIT R COmbination Plumbing IWORK�Iteration � Elxtric <br /> I TYPE D Demolilion n 1YPE New Gas <br /> U Spnnkler Rapair/Maint. Other <br /> CONTRACT PRICE OF WORK CITV OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK^DE�RIp7�pN � f�hi t_� � 'I— IQ(�'� � � �� � � \*'��/� ��� , 1 � � �ICX1� " n <br /> :�`1 � ���J T� 1 <br /> �J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FU(TURE OFi REM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET NC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHO\NEF _ IINIT HEATERS <br /> KITCNEN SINK R DISPOSAL CLOTHES DRYER <br /> DlSHWASHER RANGE H000 <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACFJSTOVE <br /> UR'NAL FIREPLACE INSEFT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PFEVENTER _ GAS PIPING <br /> � SINK(SERVICElBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> — y — <br /> 1 HEREBY CEPiTIFV THAT I HAVE READ AND EXpMINED THIS APPLICATION AN�KNOW TME SAME TO BE TRUE AND CCRFECT. AlL <br /> PROVISIONS OF'W WS AND ORIDINACES GOVEHNING THIS NPE OF WORK WILL BE COMPIIED WITH WHETHCR SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PflESUME TO GIVE AUTHORITV TO VIOL4TE OR CANCEL THE PFOVISION OF ANY OTHEii <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTfiACTOFSIAW iB.27 RCW AND 296.?.00 WAC. <br /> Signature of Owner/ConlractodAuthonzed Agent ale <br /> ■ <br />