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pCFiMIT APPLICATI(�.� <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.N PERMIT• <br /> �S Fi �'/�o� u��4 m �zto -03 -- <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 7JP PHONE t�ZS- '�/O 'VS� <br /> sfpal R<<N��sd,.� �y�9 � �� I�v � �E �+-���a <br /> TENANT NAME �. I CONTACT NAME, PHONE <br /> CONTHACTOR �wNQ�p AODRESS LP CONTR.LICENSEN <br /> U� <br /> PHONE ��.y/ �� �^ (�_ . ( s�-(.!'�G <br /> � , ii�v fl/ty ��f <br /> PROPOSEO USE OF BUIL�ING f� BUilding �"') MeChenical Addition HEAT SOURCE <br /> PERMIT �_� Combinatien �_� Plumbing WORK R Alleralion �Electric <br /> TYPE �l Demolilion IJ Sign 7YPE � New Gas <br /> L� Sprinkler Repcir/Meint. Other <br /> CONTRACT PRICE OP WORK CITY OF EVEREIT LOCAL SALES TA%COOE IS 3105 <br /> WORK DESCRIPTION <br /> �--��s�l � ��� ��r c►2 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR REM NO. TYPE OF flXTURE OR REM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DFYER <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 DRA�N _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICEIBAR/MOPfETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I - - <br /> � I HEREBY CEAITIFY THAT I HAVE READ ANO EXAPdINED THIS APPIICATION AND KNOW THE SAME TO BE TflUE AND CORRECT. ALL <br /> PROVISIONS Of LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH YJHETHER SPECIFIED HEAEIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL T4E PAOVISION OP ANY OTHER <br /> STATE OR LOCAL LAW REGULATIN ONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED FiY THE <br /> OWNER OF THIS PROPERN T ER ORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA RS LAW 18 27 F A 296.200 WAC. <br /> /a � Z3-oz <br /> �� <br /> Si nal o OwnedCo orlAuthorized Agent Data <br />