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� =RMIT APPLICAT: �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810 - FAX 325-257-6857 <br /> SITE ADDRESS PARCEL TAX I.D.+/ PERMiT� <br /> '�/J9i-7J�-vaG-orwF �0�7-0/ <br /> , . <br /> LEGA LOT N0. BLOCK TRACT ` <br /> DESC. . _ ` <br /> OWNER A�DRESS ZIP PMONE <br /> S,�oT7�.4c �-ar Ecr.c� aZ707�� � �t' I�o�1 �tj�oi � S� �;YU�i <br /> TENANTNAME CONTACTNAME PHONE <br /> I �2Ai C.4 . =oc ,�I �1�c �: R vv�� <br /> CONTRACTOP. ADpRESS 21P CONTR.UCENSE I <br /> �%G/n/G Cc' <br /> PHONE <br /> PROPOSED USE OF BUILDING Building f'1 Mechanical Addilion HEAT SOURCE <br /> PERMIi Combination K Plumbing WORK R�! Al�eration R Electric <br /> TYPE Demolilion LJ Sign TYPE u New �] Gas <br /> Sprinkler U qepair/Mainl �� Other <br /> t=i i9 i..i nv�' i9C L <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3f05 <br /> WORK DESCRIPTION <br /> S /�%�z ,;,.� I�.2 M,`T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE Oq ITEM <br /> _ WATERCLOSET A/C--A/HANDLINGUNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � _ SHOWER UNIT HEATERS <br /> I _ KITCHEN SINK 8 DISPOSAL = CLOTHEE�DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRYIFAY WATER HEATER <br /> _ CLOTHES WASHER METALFIREPLACfJSTOVE <br /> � _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DFAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> __ OTHER _ OTHER <br /> I HE�iEBV CERITIFY THAT I HAVE READ AND EXAMWED THIS APPLICATION AND KNOW THE SA�dE TO BE TRUE AN�CORRcCT. ALL <br /> PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TVPE OF 1YORK WILL 8E COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> NOT. THE GI7ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR�OCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THPT I PM AUTHORIZED BV THE <br /> OWNER OF THIS PFO TY TO PERFORM THE WORK FOF WHICH APPL�CATION IS MADE AND I COMPLY WI1�H TH�STATE <br /> CON7 CTOAS L1�B 27 RC AND 296.200 WAC. <br /> � <br /> � �D o0 <br /> Signat oi OwneUContractodAWhorized Agent � �ate (� ��-� _ v� � <br /> . .---- -- �a / <br /> i <br /> I� <br />