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P���MIT APPLICATI�.J � <br /> CIT�f OF EVERETT PERMIT SERVICES <br /> 3200 CEDAA STREET, E`rERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE aDDRESS PARCEL TAX I.D.N P=_ I7� <br /> 10 2 (� �1t�(�i ��� <br /> LEGA LOT N0. BLOCK 7FACT /� <br /> DESC. �o� 7� [ � � Z �i �tC.t����f. I.�f V/`alT�y`\�/"� •/ <br /> OWNER AODRESS ZIP PMONE Z <br /> 1 c��� � � � � i.c) � 98 20 3 - <br /> v ��e f sLti.� -�o2U( C'D,.���t�fria �V'�e C—w/erett 35�-231 <br /> TENANT NAME I CONTACT NAME PHONE <br /> �—�-- <br /> CONTRACTOR S � t ADDRESS ZIP CONTR.UCENSE� <br /> PHONE <br /> PROPOSED U E OF BUILDING Building �4echaniCel Arldition HEAT SOURCE <br /> 7ERM�T Combination � Plumhing WORK�Alteration '�—'( Eler,rk <br /> C74 Qv� 7YPE Demolition Sign 7YpE New ,�l <br /> ( p S nnkier '7� �..,j Gas <br /> �y� P C P Repair/MeinL U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � . . . <br /> �7'(D ft-l��i�. $J I LD IwlCs l(�� �c 16� !/d� 4,X �O� C,��2F�J <br /> pop�c•f-►- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTURE OR • � <br /> _ WATER CLOSET _ A/C-A/HANDLING UNITS <br /> _ BATHTUB _ FdRCED AIR SYSTEMS • � I <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP ' <br /> _ SHOWER _ UNIT HEATERS ' <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(3ERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> � <br /> i — <br /> I NEREBY CERITIFY THAT I HAVE READ ANO EXAh1INED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALl <br /> PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS 7YPE OF WORK WILL BE COAIPLIED WITH WHEfNER SPECIFIED HEPFIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING COMSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOR.N THE WORK FOR WHICH APpLICATION IS MAOE AND I COh1PLY WITH THE STATE <br /> CQNTRACTy)RS LA 8.27 R W A 296 200 WAC. <br /> / <br /> - -� `r'�fo z <br /> Signature ol OwnedConlractor/Aulhorizetl Agent ' � y�'s'e— �" <br /> I�I <br />