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�. ERMIT APPLICAT �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT a <br /> i S �0 I DU I T�o a rl-c�a� <br /> LEGA LOTNO. i BLOCK T7ACT 'l <br /> DES0. I O qODflE55 v ZIP � PHONE,e <br /> OWNER TZJ-353-�J <br /> la-rhar���L.-U111��— � q�.5 I,I v�nPV �r �2 IZn�. uoi�> � l�)a ���— <br /> TENANT NAME I CON A T NAME PHONE <br /> Tr � � _ . � 5• , I <br /> CONTRACTOR I ADDRESS ZIP CONTR.LICENSE p <br /> '—j��V�I�T <br /> PHONE �U � (1^ � „ , _ <br /> �r�� rl� <br /> PROPOSED USE OF BUILDING �Bmldmg D Mechanicai Addit�on HEAT SOURCE , <br /> PERMIT Combinalion I ) Plumbing WORK R Alleration �Electric � <br /> Tanniv�c� SUI�� TMPE Dem0li�iofl D 5��� n'PE R NeW ca5 <br /> Sprinkler U Aepair/P.4aint. Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 �� <br /> 3,�,� .— � <br /> WORK DESCRIPTION • <br /> P�rNtion.s ��� �uv�t� �nc� roo�nS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIY.TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET _ A/C—A/HAN�LINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATEFiS <br /> KITCHEN S!NK 8 DISPOSAL _ CLOTHES DFIYER <br /> DISHWASHEP _ RANGE HOOD <br /> LAUNDRY TRAY _ VUATER HEATER <br /> CLOTHES WASHER _ METAL FIRE?LACE/STOVE <br /> URINAL _ FIREPLACE�NSERT <br /> DRIIJKING FOU�ITAIN _ GAS FIREPLACE <br /> i FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> I _ SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST FAN <br /> 'i OT4ER _ OTHER <br /> I — --'- <br /> I HEFEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PRO`/1SION5 OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH VlHETHER SPECIFIED HEREIN OR <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 REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER F THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRF�TOFS LAW 1827 RGW ND 296200 WAC. <br /> � � I�� `/O�. I <br /> 'Signalur Ow er/ o ractor � orized A r.t ate <br /> (3� �;ll " o�`� <br />