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PERMIT APPLICATION <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.ri PERMI7 a <br /> E5�'>o � E'v E�C��2�=�n1 wA`( Sa3� t-Qr/ I <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS LP PF10NE <br /> TENANTNAME CONTACTNAME PHONE <br /> µ��« � -�� 6��. cl�� �153� ��Z_76a� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEA <br /> slr7N �UYS co�• i� i� s. ay-i s-r PL �WS Fa'Er:�� wAY -�003 SIGN�-�oytS-Z <br /> PHON��S�� �,/Z�3 �I�g I <br /> `f <br /> PROPOSED USE OF BUILDING Building Mechanical D Adtlition HEA7 SOURCE <br /> PERMR B Combination � Plun bing WORK �Alteration (� Electric I <br /> TYPE D Demolilion Sign TYPE New � Gas <br /> U Sprinklar(a of hends) RepaidMaint. Other i <br /> CONTRACT PRICE OF WORK ���r � c_ CITY OF EVEflETT LUCAL SALES TAX CODE IS 3705 I <br /> —r� D v <br /> WORK DESCRIPTIOnNC � I � <br /> l�.st�x �o Se�- Ckc�-+,i4+QI (�'N�r< S `� . �I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF FIXTURE OR REM <br /> _ WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS I <br /> __ LAVATOflY(WASH BASIN) HEAT PUMP I <br /> _ SHOWEfl _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY 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 FAN <br /> OTHER _ OTHER <br /> I HEFEBY CERITIFY THAT I HAVE READ AND EXA1.11NFD THIS APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE CO�dPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />� IJOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIV TO VIOLATE OR CANCELTHE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CCNSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM T E 1NORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO 18f? RCW AND 296. WAC. <br /> % � i�C/ �� <br /> Sign re of r1eN trdcto uth ' ed Agent Date �/Z <br /> /l <br />