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,.. <br /> I' cRMlT APPLICATIJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425457-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # � PERMIT x � / <br /> IZ l S v ' Ma � a� 28 o��g oo�f oz bo ��`o�a-- <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> Co E <br /> TENANTNAME I CONTACTNAME p PHONE <br /> M i �e. �l�.e��l 8��10 ' <br /> CONTRACTOR ///��� ADDRESS 21P CONTR.LICENSE q <br /> r/// /// I, � ���4 N�. <br /> PHONE \�GU�YI���/v <br /> PROPOSED USE OP BUILDING Building i� Mechanicai Addilion HEAT SOURCE <br /> PERMIT R Combinatior �_� Plurr�bing WOHK R Alteration � Eleclric <br /> �n/� �� TYPE D Demolilion LJ Sign TYPE D New Gas <br /> a U Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK //_ �l CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> U/ l/U� <br /> WORK OESCRIPTION � <br /> s`�`°`°�- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF FIXTURE OR ITEM <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& DISPOSAL CLOTHES DRYER <br /> I � DISHWASHER — RANGE HOOD <br /> LAUNDRY TRAY ` WATER HEATER <br /> i� � __ CLOTHES WASHER _ METAI.FIREPLACE/STOVE <br /> UFINAL FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> P.ACKFLOW PREVENTER GAS PIPING <br /> , SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER QTHER_ <br /> � ' — <br /> i — . <br /> ! I HEFEBY CERITIFY'HAT I HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVEANING THIS TYPE OF WOFK WILL BE COMPIIED WITH WHcTHEfl SPECIFIED HEREIN OR <br /> I NOT. 7HE GRANTING OF A PERPAIT DOES NOT PRESUME TO GIVE AUTHORITY TO�;IOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF i.ONSTRUCTION. 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 /> CONTRACTORS LAW 78.27 FCW AND 296.200 WAC. <br /> � SignaWre ol OwnedConlractodAuthorized Agent Dale <br /> � <br />