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. � ?ERMIT APPLICA' �ON <br /> �T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 /� <br /> , ,i�ltJ _j C `� ���� <br /> SITE ADDRESS PARCEL TAX I.D. � PERh117 a �'i <br /> � �' _' -� -L' �_\ <br /> , '� C `�1 i C'O <t h�i` ��-5 i G I S o C.� , �� <br /> � LE�3AL LOT N . BLOCK TRACT <br /> ' DESC. I S "1 ( �' � %j 1 � <br /> OWNER ADDRESS ,� ZIP PHONE � ���_ ,, <br /> � �.//� � / <br /> � TEN�NT�h1E �� ��� �� ��� � C� T�CTNAME��L(�CT1�/�I �� ����r��PHONE�'�-�135��1. <br /> �C7� 1� �� 1� <br /> ; ' � �r=�� ��t �,vl � � �1 � �11�i�ti� �'���' ����� 1 - s - �� �, �;���: ; <br /> � CONTF CTOR -��� �� �� ��� ��.�����ADORESS ZI CONTR. LICENSE A ' <br /> . PHONE � ,� (- /��n .=a-flit—r�! `�/� � �D � <br /> > �� f-f�"�`.�"' <br /> �, PROPOSED US[OF BUILDING �Bwldin9 � 6lechanical Adddion HEAT SOU(iCE �'. <br /> ' PER611T Comhination Plumbiny WORK Attuwuan n�—( Electnc <br /> TYPE �emolition Sign TYPE New �( �a� � <br /> Sprinkler Re�aml.ta�nt L' Oiher <br /> CONTRAC7 PRICE OF WORN CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 � <br /> � <br /> ' YlORK DESCRIPTION �., <br /> ��lC f;lU Ll� ��C�l�(��� �-� f�j> i� I�G�6� �%\•�'� � f c>�(� F-� � <br /> I <br /> � PLUMBING MECHANICAL <br /> N0. TYPE OF PI%TURE OR ITE�d NO. TYPE OF FIXTURE OR ITEA1 , <br /> WATER CLOSET __ AiC—A�HANDLING UNITS � <br /> BATHTUB _ fCRCED AIA SYSTEMS <br /> LAV�ITORY (WASH BASIN) _ HEAT PUh1P '� <br /> SHOWER UNIT HEATERS <br /> KITCHEfJ SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNpHY TFAY WATER HEATER <br /> ' CLOTHES WASHER METALFIREPLACE;STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLCOR DRAiN GAS RANGE <br /> BACKFLOW PREVENTcR _ GAS PIPING ', <br /> SINK iSERVICE.�DAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ _ OTHER <br /> I <br /> I HEREBY CERRIf'f THAT I HAVE REAO AND EXAM17INED THIS APPLICATION AND KNOLV THE SA�dE TO BE TRUE�ND CORRECT. ALL <br /> PPOVISIONS CF LAIVS ��ND ORIDWACES GOVEfiNING THIS TYPE OF WORK WILL BE COAIPLIED WITH WHETHEF SPEGFlED HEREIN OR <br /> .^!0T i HE GFANTING OF A PER�+11T�OES NOT PRESUME TO GIVE AUTHORITY TO VICWTE OR CAMCEL 7HE PROVISION OF APJY OTHER ' <br /> STAT'e OR L9CAL LALV REGULATINii CONSTRUGTION OR i HE PERFORMANCE OF CONSTFUCTION. THAT I Afd AUTHORIZED BV THE � <br /> OWNEP OF�THIS PFOPEP�1'TO PERFORM THE'•ti'ORH FOR WHIGH APPI.ICATiON IS!dA�E AND I C01dPLY WITH THE STATE , <br /> COP�7f�FCTORS LAW /82i RC'.N AND 2962C0 WAC. �. <br /> �_,c�Ll- / � f� .�`il�c'G� ��� <br /> gnatu � '� . �eriCgl�lrac� Au� d Ag�n� Date � , <br /> i f'`/'`� �7 � /2 <br />