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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, F.VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. M PERMi7 x <br /> 47i7 � eR �E bO � c�1� U G- r �� ` ���� <br /> IEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �ARRY t4WARA S �1717 �iARO NFR A✓E" 9BL�? 9tS-y38-1930 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR A�DRESS ZIP CONTR. LICENSE p <br /> PHONE � � <br /> ("� ���J�� <br /> PROPOSED USE OF BUILOING QQ Building n Mechanical Addition HEAT SOURCE <br /> PERMIT � Combinalion F_� Plumbing WORK � Alteration � Electric <br /> � � �7 TYPE Demolilion LJ Sign IYPE New Gas <br /> � �\ Sprinkler RepaidMainL Other <br /> i CONTRACT PRICE OF WORK � �0�D 00 ��GS S, CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I � <br /> I WOHK DESCRIPTION <br /> '�, , �Z c� s�F, � <br /> -����.� � Q�l'�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C —AlHANDLING UNITS <br /> I BATHTUB _ FORCED AIR SYSTEMS <br /> J_ LAVATORY (WASH BASIN) HEAT PUMP <br /> � SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER h1ETAL FIREPLACE/STOVE <br /> UHINAL 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 CEAITIFY THAT I HAVE P.EAD AND EXA�dINED THIS APPLICATION AND KNOW THE SAh7E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH INHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUh1E TO GIVE AUTHOR�IY TO VIOLiTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STAT CR LCC �W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOPI2ED BY THE <br /> OW R OF T S P OPERTY TO PERFORM THE WORK FOR 4VHICH APPLICATION IS h1ADE AN�I COh7PLY WITH THE STATE <br /> CO ACT RS W 18.27 W AND 296.200 WAC. <br /> / -3� - oz <br /> iqn� re ot OwnenConirec�onAwhorized Agent Date <br /> � ��z <br />