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P�RMIT 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.p <br /> / /�n��� ,/ e PERMI7# <br /> � �� ���� 8sy c�s -oiZ <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ���1-�r� � +-C(C�irr �rU✓ y9 / Gl�r�c�/� 98ao� �1dS �Sa s-� a <br /> TENANTNAME CONTACTFORPERMIT <br /> / I � Cl�b�e PHhomt <br /> �1�Q c c!/ — �/a.S-3 7S'(o� <br /> CONTRACTOR r' ,./ AUDRESS <br /> a"�� ZIP CONTR.LICENSE�I <br /> PHONE <br /> PROPOSED USE OF BUILDING BUilding MechaniCal <br /> PERMIT R Addition HEATSOURCE <br /> Combination Plumbing WORK I� Al�eration (� Eledric <br /> TYPE Demoiill0n Sign 1YPE u New D Gas <br /> Sprinkler U RepalUMaint. U Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORK DESCRIPTION <br /> �Qvr78�fi�t (4 n�� �c`�Q�' 6 h'�r� ��-�'CtG✓,Ps . <br /> PLUMBING MECHANICAL <br /> N0. TYpE OF FIXTURE OR ITEM NO. TYpE OF FIXTURE OR�TEM <br /> _ WATER CLOSET(TOILET) _ q/C—A/HANDLING UNITS — <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER <br /> LAUNDRY TRAY _ RANGE HOOD <br /> CLOTHES WASHER _ WATER HEATER <br /> URINAL _ METAL FIREPLACE/STOVE <br /> DRINKING FOUNTAIN _ FIREPLACE INSERT <br /> FLOOR DRAIN _ GAS FIREPLACE <br /> BACKFLOW PREVENTER _ GAS RANGE <br /> _ SINK(SERVICE/BAR/MOP/ETC.) ' _ GAS PIPING <br /> OTHER _ EXHAUSTFAN <br /> —' _ OTHER <br /> II HEREBY CERITIFY THAT I HqVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAM=TO BE TRUc 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 CANCEL THE PROVISION OF ANY OTHER <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER F T PROPF�TY TO PERF�/'V WORK FOR WHICH APP!.ICATION IS MADE AND I COMPLY WITH ThIE STATE <br /> CONT T �27 RCW AN 9 .2 AC. <br /> ��� <br /> Signature of wner/ContractodAuthonze gent te <br /> �Es:. REDIT CARDS ARE NOT ACCEPTED <br />