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�''ERMIT APPLICA�DN <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.t PERMIT M <br /> � O + b..) `J �`�I <br /> LEGA LOT NO. BLOCK TRACT I <br /> DESC. � 3 <br /> OWNER ADORESS l S�� O _ , �p ��P PHONE � <br /> �j M � ��M.i�rE..+� n�S�..�'a �' f3.Q.d cv�..� wk �t4�� � � <br /> TENANTNAME �}hl' NAM QN.A�Ln� ONTACTNAME 4�5_ PHONE � <br /> Glt/�w� H M NGt N E I �ItA-�1t M NGr�.a �,� 2 b l - 9 St�6 <br /> a - a _ t � <br /> CONTpACTOR � � � � AODRESS �P CONTR.LICENSEN <br /> PHONE �\r t }��''�' <br /> PROPOSED USE OF BUILDING Build(ng Mechanical Additfon HEAT SOURCE <br /> PERMIT Combinalion Plumbing WORK Alleretior Electric <br /> TYPE Demolitlon Sign TYPE New �p� <br /> Sprinkler HepaiNMaint. OtMr � <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 0106 � <br /> WORK OESCRIPTION � <br /> � � <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FlXTURE OR fTF.M NO. TYPE OF FlXTURE OR ITEM <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 DISPOSAI �,_ CLOTHES DRYER <br /> i _ DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> 1_ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAI _ FIFEPLACE INSERT � <br /> I _ DRINKING FOUNTAIN _ pAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE � <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> j _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> i _ OTHER _ OTHER <br /> I — _ � <br /> �� I HEREBV CERITIFY THAT I HAVE READ AND EICAMINED 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 COMPUED WITH WHETHE(i SPECIFIED HEREIN OR <br /> NOT. THE ORANTING OF A PEAMIT DOES NOT PRESUME 1'O GIVE AUTHORIN TO VIOLATE OR CANCEL THE PRCVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TNE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATON IS MADE AND I COM?LY WITH THE STATE � <br /> CONTR CTORS LAW iB27 RCW AND 298.200 WAC. n <br /> �� �����1.t� �M� �iac C+ewwO 0''.�,�, �3✓OZ— <br /> 5ign re o wner/ ontract d uthonze gent ��ja <br /> ���.Oa� � y�s alo .n 'lZ <br />