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� <br /> ERMIT APPLiCA�t�ON <br /> �ITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810– FAX 425-257-9R5; <br /> SITE ADDRESS PARCEL TAX I.D.# �Q�P,ERMiT rt � <br /> /203 5.E t�eev,{� rnAN w/ /303/0 - 03 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> TENANT NAME I CONTACT FOR PERMI7 PHONE <br /> �1 5 <br /> CONTRACTOR �„�S Sch�e,I�G� Gfly/IUMqi�v�ESS �Q ZIP CONTR.LICENSE# <br /> A/�.C��cch�� 2lz A /�iu��Rsad g273 <br /> PHONE.��4/�-G65� /hsUh��/L/ZNM� G✓A 9 c,+y P�, �9asm3 <br /> PROPOSED USE OF BUILDING Building f� Mechanical Addilion HEAT SOLRCE <br /> PERMIT R Combinalion �_� Plumbing WORK R Alteralion (7 Electric <br /> 1YPE g Demo�ition LJ Sign TYPE g New � Gas <br /> f/AiR Sa�ON Sprinkler Repair/Mainf. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CCDE IS 3105 <br /> WORK DESCRIPTION <br /> �C�GUv-��- l.vil'fC2 ��P��2 fld Y� SN�lS f}�J� i9��a GuaShc✓C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) 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 DP.YER <br /> DISHWASHER RANGE HOOD <br /> 1. LAUNDRY TRAY 1� WATER HEATER <br /> 1 CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. ALL <br /> PROVISIONS OF fAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1tIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL IAW REGULATING GONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THI PROPERTY TO PE RM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> CONT .,TO '18.27 RCW A 296.200 WAC. <br /> / //-l�•03 <br /> ignature of Owner/ ontrector/Authorized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACGEPTEQ �j I — QO <br />