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PL.�MIT' APPLICATIC� J <br /> CITY OF EVEFSETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE AD�RESS PARCEL TAX I.D.# PERMIT x <br /> a�'/0�7 CU�C.P�L—�i1! �1'i - ' ,3 C5,1-C— D 3>�— <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS ZIP PHONE <br /> /� 5�7f.srcf �(.�i'-�.rs�0.�'E/�� S70/ �,d4G� Q�"ZQ3 �� ZSZ-3GY/ <br /> TENANTNAME CONTACTNAME ' <br /> �. PHONE <br /> �I��-� �I'!i9 ��D/�� <br /> CONTRACTOR � �, p.ODRESS ZIP CONTR.LICENSE A <br /> L-I/C/ZC�kC.�U (�� f{�i � �. <br /> HON � <br /> �i_s zs2 - �av ��!r G�.�s�,�i�Ui�i�-t-, l�r 9�1�� E��sscezo7- <br /> PROPOSED USE OF BUILDING Building echanicai Addition I HEAT SOURCE <br /> PERMIT Combination Plumbing WORK �R—( A'lteralion n Electric <br /> J'��`c /� TYPE Demo�ition Sign TYPE �'M1lew . �. �d{'r;as <br /> (,/r(�� /�C�}�/L/ Sprinkler U RepaidMainl. I LJ Other <br /> CONTRACT PRICE OF W /,�j�j�,�� CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> %l/ <br /> WOqK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATEF CLOSET A/C—A/HANDLING UNITS <br /> _ BATHTU� _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK& DISPOSAL _ CIOTHES DRYER <br /> _ DISHWASHER _, RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _, FIREPLACE INSERT <br /> _ DR�NKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFI.OW PREVENTER _ GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PAOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OR <br /> MOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THI PFOPERTY T R ORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC O L4W 78.27 R W A�I 296,200 WAC. <br /> � -ZD-03 <br /> Signal re of OwnedCon ractoUAulhorized Agent Da�e �! <br /> /Z <br />