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( � <br /> PERII�IIIT APPL.ICATIOrJ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PpRCEL TA%I.D.f! rERMIT# <br /> 33 a �. ,�. � - -r o -��� -���� c��oq-a� <br /> LEGAL LOTNO. BLOCK TRAC <br /> DESC. � 7 –� I 1�� � �I U <br /> OWNER I ADDRESS I PHONE <br /> � �'QI��.,... � a �, Sa � k����) � �� � l'� lb,� I <br /> TENANTN ME CONTACTNAME P ONE <br /> � � - �4s � <br /> �' � � i . 0 31 �fs <br /> CONTRACTOR 5 � , ,� ADDRESS CONTR. LICENSEN <br /> PHONE ( <br /> PROPOSED USE OF BUILDING � 8uilding �Mechanical �Addition HEAT SOURCE <br /> PERMIT CombinaUon Plumbing WORK Aiteratlon � Eiectnc <br /> TYPE Demolftion Sign TYPE New Gas <br /> Sprinkler Repa!rlMaint. Other <br /> CONTRACT PRICE OF WORK �DO:� CITY OF EVEqETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION U vw � ,.� e 3 r� Oc�Y r e � ��� �'� 1 ��— <br /> 1 /� � <br /> �'e"5 T rU U�n. S 1'� U- 1ti�1 .t 1 S ��l C�y' P 4 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF Fl7(TURE OR ITEM <br /> h WATER CLOSET _ A/C–A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS � <br /> �_ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br />' _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> T DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PFEVENTER GAS PIPING <br /> _ SINK(SERVICElBAR/MUP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> 1 HEREBY CERITIFY THAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNON'THE 54ME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOAITY TO VIOIATE OP.CANCEI THE PROVISION OF ANY OTHER <br /> STATE OP,LO�AL LAW REGULATING CONSTRUCTION OR THE PERFORh7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> OWNE �THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON A ORS 18.?7 RCW AND 2 . 00 WAC. I <br /> �/ � C� ' <br /> Signature o n r/Contractor/Au orized genl ate <br /> 'IZ' <br />