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I — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE A RESS PARCEL TAX I.D.N PERMIT x <br /> s I� E�rcar� w Y oo s z � o z �or -oo S'oao�ct� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNEq ADDRESS ZIP PHONE <br /> TENANT NAME CONTACT NAME PHONE <br /> (�o�.S �'A�P�TS I G-oR.l�ot, �"=L�itJ y2S'�35 a -6g`y <br /> CONTRACTOR Qn��O N�N LNG ADORESS�({�'�� �61N�� N �,�J� LP CONTp,LICENSE M <br /> �ir <br /> PHONE �"�'�R'`'sv��''L W�R , 9�'2�l �M'occ.N�ay�{o D <br /> �bo�65Z�3d z,cy ' <br /> PROPOSED USE OF BUILDING n Building �Mechanical I"1 Addilion HEAT SOURCE <br /> PERMIT �_� Combinalion Plumbing WORK 1 pueratir,n (7 Electric <br /> rvae �j Demolition Sign TYpE 12g New Gas <br /> CQ�d(G���v U Sprinkler 1�.� Repair/Mainl. B Other <br /> LI�TL�% <br /> CONTRACi PRICE OFIWORK ' 6�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCHIPTION n�HIUE �/STJNG' S�G'`I <br /> �� �M �o t t4 �' [N 5T9'c,(, <br /> cu STs n��S �� s �u� a.,� �snN�- /�ozE, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FU(TURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> WATERCLOSET _ A/C—A/HANDLINGUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDFY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINK�NG FOUNTAIN _ GAS FIHEPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS FIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIl'H WHETHER SPECIFIED HEREIN Ofi <br /> NOT. 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 qEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br /> OWNER F THIS PFOP TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT A TUFS L.1W 8.2 RC AND 296.200 WAC. <br /> W� � 0 � <br /> Signalure of Owneu ontr to/Authorized Agent ��� / <br /> � e� �z <br />