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( <br /> �ERMIT 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.X PERM � � <br /> ��' S� � / A / 7 O <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PNONE <br /> CJie�-c�,e � �a � �,� aP�l J����� < < � ��o i �f���J a5'a 3/�� <br /> TEN TNAME I CONTACTFORPERMIT PHONE <br /> _..►�,�h � szd % � h t� Rr� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE 11 <br /> �c,hv�l� ri �.o �c�a��{-. �3c�� ��-�y-� ��'�r.l <br /> PHONE � � � �e Nvc���n��Kv <br /> -- S' -3 �r ' <br /> PROPOSED USE OF BUILDING BUildinr� I7 MeC nical Addition HEAT SOURCE <br /> PERMIT Combinalion �� Plumbing wORK �teratlon R E.1cUic <br /> �--� �j Gas <br /> TYPE Dem0lilian LJ Sign TYPE ew <br /> • Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK�•� ��/��, �� CITY OF EYEBETT LOCALS�ES TNFCODE IS 3105 <br /> �rl �g / +7g�w 3��✓�/ !�I/� <br /> WORKDESCRIPTION /�F���I�/2 YCKI'.�� / ' f'NL' • � • •� � ---�- .. .��. : � ��� �-i��-_ <br /> �7� ��P� r"5=c:t� Q���'s� i9��fl f/f1N'D ��A��s �,�h ,$Ar�C�st��es <br /> �i�G�pv�=, '13r1lGorv� �r,1s�F�f��� SEC�c,�'O s�ad=y Y'�n�CRr",� �'�Ai� ��'� <br /> � � r) �� _ - �-' <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ FVC—AIHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHFS QRYER <br /> DISHWASHER _ �NGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTFIES WASHER _ META�FIREPLACE/STOVE <br /> URINAL _ FIREP;ACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAAfINED THIS APPLICATION AND KNON'TME SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR C.WCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORfv1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER 0 IS PROPERTY TO PERFORM THE WORK POR WHICH APPLICATION IS AIAOE AND I COMPLY WITH TH'c STATE <br /> CONT TORS .� CW ND 296.200 WAC /, <br /> � —7 - .�� / � <br /> Sign ture of O er ontrac odAuthorized Agent Date ` , <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEFTED <br /> �1i <br />