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P�RMlT APPLICATIL �V <br /> GlTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> ,'I�2� <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT M �O <br /> C�co�.� �T0.� ��,�-t� s,�.r� e�-�aoaa,o�a s� C�C�- ' 9 <br /> LEGA LOT N0. BLOCK TRACT <br /> OESC. � 2�-Q L���'j'�l.f_100 <br /> OWNER AODRESS g a'� ZIP PHONE 3(�� <br /> `� .�co�. �ov�n.c2S �.v.c. e�C7.�o�. allo�t I(1�r_N��,i.��� UJ14- (053-38�� <br /> TENA AME CONTACTNAME PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> PNONE S a ��,� C��-ac.r t�=o3al�y� <br /> PROPOSED USE OF BUILUING uildl�q �p�AAechanical Addilion HEAT SOURCE <br /> PERhh1T �ombination ��PIUtl�bl�g WORK Allaralion nc <br /> Sv� TYPE Demolilion � Sign 7YPE ew Gas <br /> \ � Sprinkler RepaidR,aint. O�her <br /> CONTRACT PRICE O.'-WORK ��Q I CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 — <br /> WORK DESCRIPTION `1�� S\��I� �0.wi\ I � _ � 1_ � 1 �O� 1 � C ��-� <br /> �v \ \ Y� C�. I J <br /> 3` c°'s �-- S ��� 5 ,F' ,f���.c� ZZC13 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TUHE OR REM NO. TYPE nF flXTURE OR ITEM <br /> WATER CLOSET AIC-iVHANDLING UNITS <br /> BATHTUB J_ FOACED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) ^-= HEAT PUMP <br /> — SHOWER "' UNIT HEATERS <br /> j � KITCHEN SINK 8 DISPOSAL � CLOTHES DFIYER <br /> DISHWASHER � RANGE H000 <br /> IAUNDRY TRAY _� WATER HEATER <br /> �_ CLOTHES WASHER � METAL FIREPLC.CE/STOVE <br /> — URINAL ^— FIREPLACE INSERT <br /> `-- DR�NKING FOUNTAIN � GAS FIREPLACE <br /> �- FLOOR DFAW = GAS RANGE <br /> �- BACKFLOW PREVENTER � GAS PIPING <br /> I = SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> � _ OTHER _ OTHER <br /> � <br /> I — <br /> � I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUc AND CORRL:.T. ALL <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVERNING TH�S TYPE OF WORK WIt.L 8E COMPLIED WITH WHETHER SPECIfIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF PNY OTHER <br /> ' STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZ�D BY THE <br /> OWNER OF?HIS PROPERIY TO PERFOiiM THE R WHICH APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RC ND 2 '200 WA�C.� <br /> �j S-1��0� <br /> SignaWre ot Owner/Con ractor/Au otized 4gent �a�e t/L <br />