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;� ERMIT APPLI_CATti �N <br /> rITY OF EVERETT PERMIT S�RVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT n <br /> ' f Z r AV moai�-c�sa <br /> IEGA I.OT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �1�11L1�J�d1-[�1.�L S���a��iP(� <br /> TENANTNAME CONTACTNAME PHONE <br /> Le:�-� s� K �nr� �I��ers�-r�� ��m� 51 ; - ��� <br /> CONTRACTOR Norr,eTc��Jr� I��) �r�'^�/�DRESS M�1 ���V� I I �, I^I�, Z�P CONTR. LICENSE A <br /> '�� v 1 1 <br /> PHONE J <br /> PROPOSED USE OF BUILOING (7 Building n Mechanical fl Addition HEAT SOURCE <br /> }^ PERMIT � � Combination �_� Plumbing WORK �_� Alteralion [� Electric <br /> � 1 � TYPE �j Demolition LJ Sign IYPE �,.� New �� �.] Gas <br /> U Sprinkler LJ Repair/Maint. U Olher <br /> CONTRACT PRICE OF WORhy�'(J� (�(1 `(�(,�'(`(J�( CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �� H <br /> WORK UESCRIPTION �11�1� iy I I 11�,�1 hL�� � \t�,���f � �y��py„I"� �"�Y�( JL(� <br /> V1 I 1.. l�� –� <br /> �.) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> VJATER 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 /> DISHWASHER RANGE HOOD <br /> � _ LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL Z FIREPLACE INSERT Od-� <br /> DRINKING FOUNTAIN _ GAS FIREPLACE � <br /> I FLOOR DRAIN GAS RANGE <br /> �ACKF�OW PREVENTER �� GAS PIPING <br /> aINK(SERVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> _ —I <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAh1E TO BF TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1WS AND ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BF.COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT GOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE Pi70VISION OF ANY OTHER <br /> STATE OR LOCAL LA4V REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> ������ 1 �I �7�^n��0296.2dOWAC. ��I }n1 r� <br /> 1\ /` `i Y\ <br /> Signa�ure of OwnedContractor/Authorized Agent Date <br />