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P'.�.RMIT APPLICATIL ,V <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.M PERMIT H <br /> b 3 � - �-ve 4c� G� b .1� c� <br /> LEGA �LO N� � � � CK TRACT � `Q I ^ �I ��S�S �� � <br /> C.d <br /> DESC. � � <br /> OWNER ADDRESS ZIP PHONE <br /> t��c-s K � ��-1 ��.� ��e <br /> TENANTNAME CONTACTNAME PHONE <br /> � �o r� 'I`��c"�e�S �1 a 5 aSa�l�9 <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING Building fl Mechanical Addition HEAT SOURCE <br /> PERMIT Co bination ��� Plumbing WORK � Alteration � Electric <br /> I--( <br /> TYPE emolition LJ Sign TYPE New Gas <br /> Sprinklef Repair/Maint Olher <br /> CONTRAC7 PRICE OF WORK � 1�OD CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> l <br /> WORK DESCRIPTION <br /> ��evral� S� c�`� �a�l'Q�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF Fl7(TURE OR ITEM <br /> WATER CLOSET _ A!C—A/HANDL�NG UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <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 FIREPLACEISTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> i _ BACKFLOW PREVENTER _ GAS PIPING <br /> I = SINK(SERVICE/BAR/MOP/ETC.) = EXHAUST FAN <br /> OTHER OTHER <br /> � — <br /> I — <br /> 1 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 WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO V�OLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI li1W fiEGUTATING 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 /> CONTRA TORS LAW 18.27 RCW AND 296.200 WAC. � <br /> �,4�.������ a - a� -o a <br /> Signature o Owner/Conl todAuth ed Agent Date ` <br /> 2' <br />