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P�r�MIT APPLICATIG�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> �SITE ADDRESS �)If PARCEL TAX I.D.M PERMI7 a <br /> cSO 1-s o 0 0o D�' 3-oO� <br /> .�(�LEGA LOT N . BLOCK TRACT <br /> DESC. <br /> �OWNER AODRESS ZIP PHONE <br /> � ,�a2 ��,�� Ll--� /0 50 0 �-��1ze��� 3�f 7- 5 7G 3 <br /> TENANTNAME CONT�ACT�'ME PHONE <br /> ��AM�p l��dd� ���C'P-�^ 1. dJ.�i.P.c� l��i - `7�!'S - �'/// 7 <br /> �'C T�RAAC'T�OR,,pn ADDRESS ZIP CONTR.LICENSE N <br /> �w '""' ` <br /> PHONE <br /> 1f�5' 7 �- 5 ' 4 /� 7 <br /> PRC�POSED USE OF BUILDING Building n Mechanical D Addition HEAT SOURCE <br /> PERMIT B Combinetion H Plumbing WORK L) Alteration � Electric <br /> TVPE D Demolition LJ Sign TYPE D New Gas <br /> U Sprinkler U qepaidMaiN. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> J�t WORK DEG�N „�C�K.�wV — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTURE OR REM <br /> WATEii CLOSET _ A/C—A/HANDIING UNITS <br /> BATHTUB FORCED AIF SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE H000 <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> OFINKING FOUNTAIN GAS FIREPLACE <br /> I = FLOOR DRAIN _ GAS RANGF <br /> BACKFLOW PREVENTER GAS PIPING <br /> � _ SINK(SERVICJBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> � — <br /> I - - <br /> I <br /> i <br /> � <br /> iI HEREBY CERITIFY 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 WITH WHETHER SPECIFIED HEREIN OR <br /> , NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CCNSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BY THE <br /> . OWNER OF THIS PROPERTY TO PE RM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> i CON7RACTOR W 78.27 W A D 296.200 WAC. <br /> _, , /Z �3 7 � z, <br /> Signalure of OwnerlContractor/ u orized Ag t Dale <br />