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PL�tMIT APPLICATIO� <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.7i PERMIT a <br /> &� r V` - - - `� o " <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. 5 � {-I� � T Q <br /> OWNER ADDRESS �v�;��'tY 21P PHONE <br /> 11 <br /> � .a � �ai o� . � . -�. <br /> TENANT NAME CONTACT NAME PHONE <br /> �'1'l�' S �WN � OuJf��� <br /> CONTRACTOR AD�RESS ZIP CONTR. LICENSE# <br /> OIJ�N�� <br /> PHONE �/�� _ (��j� � 2/���� <br /> � `� �JL� <br /> PROPOSED USE OF BUILDING 17 �uilding I-1 MeChanical Addition MEAT SOURCE <br /> PERMIT �+Combinalion �_� Plumbing WORK Alteralion Electric <br /> S� � TYPE �l Demolitiun LJ Sign TYPE New Gas <br /> U Sprinkler RepaidMaint. Other <br /> CONTRACT PFICE OF WORK Q/1�'J� — CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> lI/ / <br /> WORK DESCRIPTION � ��0�� ��,^ <br /> �ODIT(0�1 K <br /> z3ss� <br /> PLUMBING MECHANICAL <br /> INO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI7(TURE OR ITEM <br /> � WATERCLOSET _ A/C-A/HANDLINGUNITS <br /> i � BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> I _ KITCHEN SINK& D�SPOSAL _ CLOTHES DRYER <br /> D�SHWASHER RANGE HO00 <br /> I LAUNDRY TRAY WATER HEATER - <br /> CLOTHES WASHER � METAL FIREPLACE/STOVE ' <br /> URINAL FIREPLACE INSERT ' <br /> i _ DRINKING FOUNTAIN � GAS FIREPLACE D�j <br /> FLOOR DRAIN _ GAS RANGE � <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(S yICE/BAR/ 0 ETC.) � EXHAUST FAN <br /> = OTHER I1 _ OTHE <br /> r s:r y.✓ L_ <br /> ' I HEREBY CERITIFY'HAT I HAVE READ AND EXA`AINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> Pl70VISIONS OF LAWS AND ORIDINACES GOVEF�NING THIS 1VPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIPIED HEREIN OR <br /> NOT. THE GRANTING OF A PEflMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION 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 WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 00 WAC. <br /> -�rz��'-��C� r; � u�� fi���- oa �. <br /> SignaWre of Owner/ContractodAuthonzed Agent Date l II C �� <br />