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P�RMIT APPLICATI��V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT M <br /> QJ�� ' - ' ( �� ' ) J /!� . ��21o�arZ ( <br /> LEGA LOTNO. 9LOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PNONE <br /> %t ���r�r.i>»s�iJLt� ���,�S�d � l /C�S7��; l-=1?ti�M�7� lc��v <br /> TENANTNAME I CONTACTNAME � PHONE <br /> CONTRACTOR SC'U�l J C �?(J/�l�tl f7I� ADDRESS���.�{�_.��,fl�y,�� LP CONTR.UCENSE M <br /> � ��-,��/,� �ic��7,��c�:.vc�i4�o'� <br /> PHONE '� � <br /> �.�ti -.�7���7� v <br /> PROPOSED USE OF BUIL DING Building Mechanical Adtlition HEAT SOURCE <br /> PERMIT R Combinalion� Plumbing WORK R Alleration f7 Electric <br /> TYPE � Demolition Sign 7YPE � New F_� Gas <br /> Sprinkler Aepair/Maint. lJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION <br /> `��Cz�� !� r!ti�/ �'i���5 l , ��l� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> WATER CLOSET _ A/C-A/HAND�ING UNITS <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 /> LP.UNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> , � URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � _ FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> , SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST F.4N <br /> j � �O��TH��EyR� _ OTHER <br /> �'"_,___T- - .�� + <br /> i — <br /> I HEREBY CEFITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEfiEIN OR <br /> NOT. THE GFFNTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATr OR LOC.1L LAW FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AI�1 AUTHORIZED BY THE <br /> � OWPlER OF THIS PfiOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAyV 18.27 RCW AND 296200 WAC. <br /> � -� �� l� �. ._ � �l� �jZ._ <br /> I Signature of wnedC tractor/Aut onz �'A'gEnt Dale <br /> � <br />