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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS Svi� PARCELTAX I.D.• PERM x <br /> t�izo �c,� Go��,.� w ��4��qo��'�� 7� � /7/068 <br /> LEGA LOT NO. BLOCK TNACT <br /> DESC. <br /> OWNER/ ADDRESS �v��#�(pU ,a� PHONE <br /> VF�LP� t'�lot; �rv �S�o �4v�M �E n1E�CEonr 4��¢�-�861 <br /> TENANT NAME I CONTACT NAME PHONE <br /> ��r�2., c �cz.: s�;aa c�2 �� �. ��a.;r�o� qzS—�4i-2� <br /> CONTRACTOR� ADDRESS ZIP CONTR.UCENSE M <br /> �NIz-xNai'e.wac sry� ��. ,z�fl�f MwY rf s. �� frts,�c�ratr y��sca r�yy� <br /> PHONE �1"J �J 7'I"I ��J � � �� " <br /> PROPOSED USE OF BUILDING 1� ouilding � M��echenical Addition HEAT SOURCE <br /> PERMIT K COmbinalion U F'IUmbing WORK Alleration � Electric <br /> TYpE �,.1 Demolition L�-6ign TYPE ew Gas <br /> U Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK 3ca7�D '�'C G�4 ) C�OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORi(OESCRIPTION <br /> �TJ6.J`T�'Ll ZLLNM/Ng'7S?� S/N6�L� �O/Nl�/ 1�GJ <br /> �^`�S�/6�.�'3 y (9�i �c�G7 7o�dC /I�T7oM '�`f'c1 cW T/f& woo,/� <br /> w/�tiL r/�R�/ wuvb Jta�M. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUflE 6R REM 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 DISPOSAL _ CLO7HES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDflY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPV�CE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFIOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <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 CF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOFiK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS/LAW'��W AND 296.200 WAC. <br /> ��ie —�� //�L/ /�� � <br /> Signature ol ntractod uthonzed Agent ele � �/_ � <br /> \[�/ <br />