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PEl'�MIT APPLICATIOI� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />�•�kf� l�u�bl�l - ��. <br />SITEADORESS�OOS �7� ���Ve-��-7G3Tt91�/--�D/�� (��INII � DIS <br />LEGA LOT NO. I BLOCK <br />DESC. S',�„ � � <br />OWNER <br />� //�/L/l�� �Y/C% � <br />TENANTNAME <br />CONTRACTOR <br />����y "� - S %• .�t{� . <br />P ON <br />e�sc-_ �u G—ir'.�� <br />PROPOSED USE OF BUILDING <br />CONTACTNAME <br />ADDRESS ZIP <br />�U . ,(3dX �� �v, cu/�. <br />�6 <br />Building Mechanical <br />PERMi7 Combination Plumbing <br />TYPe �emoliUon Sign <br />u Sprinkler <br />CONTRACT PRICE OF WORK � SU, D � Ci <br />WORK DESCRIPTION <br />PHONE <br />-_ �'y� �sa � <br />CONTR.UCENSEN <br />/�try�'G<^D/OF�- , <br />Addition I HEAT BOURCE <br />Alteration tric <br />ew Gas <br />RapaiqMaint. Olher <br />CITV OF EVERETT LOCAL SALES T4X CODE IS 3105 <br />%-�/�GlJ ' � l� ��GTJv`i • . . , <br />NO. � TVPE UF FI%TURE CR REM <br />WATER CLOSET <br />BhTHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN S�NK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEJDAR/MOPlETC.) <br />OTHER <br />,: <br />NO. I TYPE OF flXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP , <br />UNIT HEATERS - <br />CLOTHES DRYER � <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />(iAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRE.T. ALL <br />PROVISIONS OF WWS AND ORIDINACES GOVERNING TNIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEPEIN OR <br />NOT. THE GFiANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFiOVISION OF ANY OTHER <br />STATE LOCAL LAW P[3UlATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWN O THI� PFOPcRTY THE WOFiK FOR WHICH APPIICATiON IS MADE AND I COMPLY WITH'� HE STATE <br />CO FAC ORS LAW 18.27 CW AND WnC. <br />_ —. _ ��-'/� � � <br />Sfgna ure of wn ontractor/ ulhonze gent ate � <br />1 <br />