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i <br /> . �ERMIT APPLICA"� .�N ' <br /> CITY OF EVERETT PERMIT SERVICES S -��-0 3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> PAHCEL TAX I.D.# PERMIT a <br /> SITE ADDRESS SO� C�3 <br /> i I rr�c ✓�� 'J12`j' Fi - - � � - �7 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. �� Z�p pHONE v <br /> OWNER A�DRESS �i2C� aSC�'.a�"�'.�b <br /> �-C"')✓�. I �} - 1 �� 20 C-n��t� ✓� c� - � <br /> TENANT NAME I CONTACT NAME , „ D _� <br /> (J'J"� <br /> .�c� �� C� <br /> � ADDRESS ZIP CONTR.LICENSE N <br /> CONTRACTOR � ��>� f�_ �'— <br /> PHONE I <br /> (� Building Mechanical Addition HEATSOURCE <br /> I pROPOSED USE OF BUILDING �{ q� Electric <br /> � PERh7iT {-( Combination Plumbing WORK Alteralion �( Gas <br /> TYPE �..f Demolilion Sign TYPE New �-( <br /> �-��'�����' L� Sprinkler RepairlldainL V oine� <br /> I � <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3705 <br /> CONTRACT PRICE OF WORK <br /> WORK�ESCRIPTION <br /> �L����. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> tJp, TYPE OF FIXTURE OR ITEM <br /> WATER C�OSET _ NC -A/HAND�ING UNITS <br /> FORCED AIR SYSTEMS <br /> BATHTUB HEAT PUMP <br /> LAVATORY (WASH BASIN) UNIT HEATERS <br /> _ SHOWER CLOTHES DRYER <br /> KITCHEN SINK 8 DISPOSAL RANGE HOOD <br /> DISHWASHER WATER HEATER <br /> LAUNDRY TRAY META�FIREPLACEISTOVE <br /> i CLOTHES WASHER FIREPLACEINSERT <br /> UAINAL GAS FIREPLACE <br /> DRINKING FOUNTAIN GAS RANGE <br /> FLOOR DRAIN GAS PIPING <br /> BACKFLOW PFEVENTER EXHAUSTFAN <br /> SINK (SERVICE/BAR/MOP/ETC.) OTHER <br /> OTHER — <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION ANO KNOW THE SA61E TO BE TRUE AND COFRECT. ALL <br /> �� PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS 1YPE OF WORK WILL BE COh1PLIED WITH WHE7HER SPECIFIED HEREIt�OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTiiER <br /> STAj-E OR LOCAL lAW REGUI.ATING CONSTRUCTION OF THE PERFOAMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> riiNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN�I COA7PLY WITH THE STATE <br /> .ONTRACT fiS LAW 18.27 RCW AND 29 00 WAC. <br /> j� i <br /> /r,�� i / � � ` � Dale <br /> � naW��-����o�ractodP,+lll n..ad Agent � : 2 <br /> ( ' <br />