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P'�RMIT APPLICATI��V <br /> CITY OF EWERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDFESS PA�f EL AX I.D.S PERMiT a <br /> SI II �JPr' YPCN . QOSQ �� OR.� O�Co oa � G2�G-�GS <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AOURESS ZIP PHONE <br /> TENANTNAME �� I CONTACTNAME PHONE <br /> CONTRACTOR�'�`�nC� ��S ��' ADDRESS�OcI� �R�� � ZIP CONTR.UCENSEN <br /> � � J / <br /> PHONE <br /> y.��- ��-.��,<, <br /> PROPOSED USE OF BUILDING Building f"1 MeChanical Addition HEAT SOURCE <br /> TYPEIr � SPrinkle�n n U Sign 6in9 TYPE F-( RlePair/Maint. U Othe,r c <br /> v LJ <br /> CONTRACT PRICE OF WORK ClTY OF EVERE7'T LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ����� <br /> � PLUMBING MECHANICAL <br /> I N0. TYPE OF FIXTURE OR REM N0. TYPE OF FIXTURE OR ITEM <br /> i <br /> 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 /> I _ DISHWASHER _ RANGE HOOD <br /> i = LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> i URINAL _ FIREPLACE INSERT <br /> DR�NKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> � 6ACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> i ,_ OTHER _ OTHER <br /> i <br /> I HEREBY CERITIFY 7HAT I HA`!E READ AND EXAMINED THIS APPLICATION AND KNOW THE SAM11E TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfNEfl SPECIFIED HEFEIN OF <br /> NOT. THE GRANTING OF A PEiiMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 0Y THE <br /> OWN R OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON RACTORS LA 8. W D 296.200 WAC. <br /> '�� <br /> ig lure o nedCum a Au o ized Agent Date <br />