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F�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 4_5-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT x <br /> /osoo ,yw ,�' So. 1 3b3��3 <br /> LEGA LOT N0. BLOCK TqACT <br /> DESC. <br /> OWNER ADDRESS ZIP PNONE <br /> , /���R/�',rc��viss,9/I/ �os� /�r�Y �7 s�- �,?�� <br /> ITENANTNAME I CONTACTNAME PHONE <br /> ' CONTRACTOR AODRESS LP CONTfl.LICENSEM <br /> C�/. � ,S/7��2�7/1�7�' C. /6// �. �192//L� !//�LfiQ/1, g$.?O/ �E�GSSo,Z,ZO� <br /> PHONE <br /> ��- �//�/ <br /> PROPOSED USE OF BUILDING Building �p( Mechanical 1��S Addition HEAT SOURCE <br /> PERMIT B Combination �l, Plumbing WORK I ) Alleration � Electric <br /> A(,[� /��L�S/S�//� TYPE D Demoliticn LJ Sqn rrae ❑ hew ces <br /> U Sprinkler � Repair/Maint. Olher <br /> CONTRACT PRICE OF WORK G 800 � CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> �` <br /> WORK DESCRIPTION <br /> ✓As piPc � �s`��c� � ��Di���7zs <br /> PLUMBING MECHANICAL <br /> INO. TYPE OF FIXTUHE 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& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHFR METAL FIREPLACE�STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR ORAIN GAS RANGE <br /> BACKFLOW PREVFNTER � GAS PIPING <br /> � _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> I _ OTHER 0 HER <br /> � .RO%Px� i <br /> � I 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 COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTFiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWN THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C TRACT RS LAW 1827 RCW AND 296200 WAC. <br /> ' .�- � 03 <br /> Signature of OwnedConirectodAut orized Agent `Date <br />