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� � - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEI TAX I.D.A PERMIT d <br /> �a � o n�n� E R c�� C�u 1l - � <br /> LEGA l0T NO. BLOCK TRACT <br /> DESC. <br /> pyyNgp AOORESS ZIP PHONE <br /> ��,��,�T ��,�RRy <br /> ' TENANTNAME I CONTAC7NAME PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.UCENSE I <br /> �, < . /��rs�oF� ,: �A.,�T,J6 �soz s�rys+�E vt acREMPcaa�o3 <br /> PHONE MiiR�l,f'v/tL� jtJf) �(fL7D <br /> PROPOSED USE OF BUILDING BUildi�g n Mechenical Additian HEAT SOURCE <br /> PERMIT Combinetion I S Plumbing WORK Al�eratlon R Electric <br /> TYPE Demolition p Sign TYPE New �._j Gas <br /> Sprinkler Repair/Meinl. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 31G5 <br /> WORK DESCRIPTION <br /> � �, ���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR REM NO. TYPE OF FlICTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> _ BATHTUB FOFiCED AIR SYSTEMS <br /> LAVATGRY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATF.RS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> UFiINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN QAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) __ E�CHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT TFiE GFANTING OF A PEf�MIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S fATE OR LOCAL LAW REGULATI�:CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> Signalure ol Owner/Contractod uthorized Agent Data <br />