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P�=RMIT APPLICATIL+N <br /> CITY OF EVERETT PERMIT SERV'ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE A f i I+'SS ��� A PARCEL TAX I.D.N I PERMIT M��/ <br /> '� ��_ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER �v� C�/ ADDRESS P PHONE <br /> �FG�✓u� <br /> IS�m Gc����1� i s!� r y�� ,rrE N�F: s N„F ,•0 7sees �''tf) 7y�—/�Ld <br /> 7ENANTNAME I CONTACTNAME PHONE <br /> ��or��io �s sugs I ST�✓� �-A�t3Ei�ci,✓ �io6) �-82-i1ao <br /> CONTRACTOR ADDRESS ZIP CONTR.UCENSE M <br /> r�R'(IIdAL SI6l✓ CU/L� 1 tsf WeSf4�!(�` �A/E. I✓• <br /> PHONE CZf6) �2�A�0� S.C��TLE QQ�Q1 i✓q9risti3nn3 <br /> PROPOSED USE OF BUILDING BUilding MechBniCel Addition HEAT SOUfiCE <br /> PERMIT Combination Plumbing WORK Alteratbn Q Electric <br /> 7YPE Demotitian � 'Sign TYPE �New I u 6ae <br /> Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK �9!f CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> (N <br /> WORK DESCRIPTON <br /> Id9(4'Li- 7vo ��/�� � I Lurryi�/►r/f� G✓It�t flo✓f. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF flXTURE OR REM <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> I _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY • _ WATER HEATER <br /> i = 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 /> j _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> 1 _ — <br /> ' I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OFIDINACE�GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> , NOT. T'riE GRANTING A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR CAL LAW EGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> �; OWNER O HIS PROP RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> j CONTRA RS LAW 7 27 RCW AND 296200 WAC. <br /> � 7�$-I'L <br /> I� Signature o wnedC ractodAulhorized Agent ate <br /> ��L <br />