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PEt�MIT APPLiCATION <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25?-8810- FAX 425-257-8857 <br /> SITE ADDFESS PARCEL TAX I.D.k PERMi7 x <br /> �_ Q` Vho I I-d I <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDHESS ZIP PHONE <br /> TENANTNAME I CONTACTNAME PHONE <br /> (�SI.C� <br /> ONT CTORI ' KI.W��ICA1 ��� �SI��• P���'1� I�+"`� �YV�� EYV��O'SC� <br /> AHONE <br /> PROPOSED USE OF BUILDING I7 Building MeChaniCal A ion HEAT SOURCE <br /> PERMIT �_� Combination Plumbing WOaK Alieralion R Eiectric <br /> TYPE {__( Demolilion Sign l"!PE New �j Gas <br /> U Sprinkl?r Fepair/Mainl. LJ Other <br /> CONTFACT PRICE OF WORK ��'�Jl CITY OF EVERETi'LOCAL SALES TAX CODE IS 3105 <br /> / lJ�� <br /> WO�Q6t5CR�N Iv �� ��a <br /> �'� ( �4�- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUFiS:F iTEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> fiATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAI. __ CLOTHES DRYER <br /> DISHWASHER _ RANGE H00� <br /> LAUNDAY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> ' URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER AS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) EXHAUST <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 ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIE�WITH WHETHER SPECIFIED HEREIN OFi <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOFlITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STA OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OW 0 HIS PROPERiY TO PERFORM THE WORK FOR WHICH APPLICATIO �S hiADE AND I COMPLY WITH THE STATE <br /> CON C RS 78.27 RCW AND 296.200 WAC. <br /> � I1 S o � <br /> Signal e w dContractodAulhonzed Agent Dale <br />