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S <br /> PERIIniT APRLICATION <br /> CITY OF EVERETi' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br />'' ✓ `T" �-� <br /> SITE ADDRESS �"$' ( �3 PARCEL TAX I.D.X I P� MIT u <br /> 1�1�� 5L, �vt�ErTf�w[��WA`r I �U�� OD� <br /> LEGAL LOT NO. BLOCK TRAC: <br /> DESC. <br /> OWNER ADORESS ZIF ?HONE <br /> TE�'.:NT NAME CONTACT NAME pHONE <br /> ' f,�, �-oµP <br /> I CUNTRACTOR 50UY1-1 Q�C�U.Yti, �(1�r��g�n� ADDRESS _ ZIP CONTR.LICENSE 11 <br /> i r.�C. r?o.go�C Cr i�� �ouT.sc�.93o � <br /> PHONE [Dr�oa��C.a�R.q��'��`�� <br /> yzs --���;--�3�t'1 <br /> PROPOSED USE OF BUILOING Building Mechanical Addition HEAT SOUfiCE <br /> � PERMIT � Combinalion Plumbing WORK�Alteralion � Electric <br /> �' TYPE Demolilion �Sign TYPE New Gas <br /> Sprinkler Repair/Maint. Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCflIPTION <br /> �}�dC S,ti,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATEFi CLOSET A!C—rVHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL _ CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> :1RINAL FIREPLACE INSERT <br /> DNINKING FOUNTAIN . GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PAEVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) _ EXH.�UST 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 LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORI2EG BY TI1E <br /> OWNEF OF THIS PROPERN TO PERFORM THE WUHK fOF WHICH APPUCATION IS�AADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ��—g <br /> Signalure of OwnedConlractor/Aulhorized Agenl Date <br />