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P�RMIT APPLICATIO�J <br /> CITY OF EVERETT PEfiMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-3810 <br /> SITE ADDRI:SS PARCEL TAX I.D.# PERMIT# <br /> ��a .,�.� i�� ys�l �� s73 003�- 00 ��i��-oa <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER 2 I ADDRESS 9��rj� PHONE <br /> �'..�/'f��� ��., U��C (��t� � �D�+cX��!*�iG 11L1: �Y��S�' 333 <br /> TENANT IJAME I CONTACT NAME I PHONE <br /> �,='1�'C�C <br /> CONTRACTOR �.r�rt—) ADDRESS CONTR.LICENSE R <br /> PHONE I <br /> PROPOSED USE OF BUILDING �Building � Mechanical �Addition HEAT SOURCE <br /> PERMIT Combinalion Plumbing WORK Alteration D Electric <br /> TYPE Demolition S�gn TYPE New D Ges <br /> �/�„, :.��r�C Sprinkler RepaidMaint. U Other <br /> ✓[J�K-ov <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION �� ' � C6z«+-G�-��� �r��� �^�''`LB-�f�Gj�-''=— ' <br /> �.� �� ��I�e�, ,�-�-k�� . -� �����d���,�� � �� i� <br /> � . <br /> 2v���� ��E�, <br /> PWMBING MECHANICAL <br /> NO. TYPE OF FIXTUP.E OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET _ AIC—A/HAPIDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY 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 _ GAS PIPING <br /> SINK(SERVICEIBAR/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 CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL bE COMPLIED WITH WHEff1ER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIN3 OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL Lf.W REGULATING CONSTRUCTION OR THE PERFORMANCE OF COPlSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH APPLICATION�S MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAVl�27 RCW AND 296.200 WAC. <br /> ,��� � �� �n_ �-�d � <br /> , , �� -� <br /> Signature of Owner/ContractodAulhonzed Agent Date <br /> � <br />