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' ,; <br /> PE MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STHEET, EVERETT, WA 98201, 425-257-8810 <br /> O /Gb <br /> SITE ADDRESS pARCEL TAX I.D.N PERMIT# <br /> � i -�.6i�- �� s�` . - n c��a -� <br /> LEGAL LOT NO. BLOCK TRACT <br /> oEs�. ,� = �� y .� ��,�r o����-F�'t/� �� <br /> OWNER ! , 'JDRESS PHONE <br /> �iS�a�E� ��/F,� �i��qs�i.y� ��,�/ �'��ir� s� I <br /> TEN?,N� NAME � I CONTACTNAME I PHONE <br /> 5���� S,���� <br /> CONTRACTOR � ADDRESS CONTR. LICENSER <br /> PHONE/.�� �� O oS� I/�G��l�7� � G�✓� I Clt�F <br /> PROPOSED USE OF BUILDING �uilding echanical Additio� HEAT SOURCE <br /> PERMIT f7 Combination �P mbing WORK Alterxtion <br /> TYPE � Demolitian ecinc <br /> D Sigri TYP� New Gas <br /> l ` / / � �,',� Sprinkler Repair/Ma�nt. Other <br /> CONTRACT PRICE OF WORK CITY OF[VERETT LpCAL SALES TAX CODE IS 3105 <br /> d <br /> WORK DESCRIPTION <br /> /��,r�,� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUAE OR ITEM <br /> � � WATERCLOSET _ A/C—A/HANDLINGUD�ITS <br /> BATHTU6 _ FORCEDl,IRSYSTEMS <br /> ' " LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER �+.`i7'f?-:��'CRS <br /> _ KITCHEN SINK& DISPOSAL _.; i.v,;_i� DRYER <br /> _ DISHWASHER <br /> _ LAUNDRYTRAY —t r''`��� IOOD <br /> _ CLOTHES WASHER — W+�TER HEATER <br /> URINAL _— METAL FIREPLACE/STOVE <br /> _ DRINKING FOUNTAIN — F�REPLACE INSERT <br /> _ FLOOR DRAIN — GAS FIREPLACE <br /> BACKFLOW PREVEtJT.EF — GAS RANGE <br /> _ SINK(SERVICE/BAR/MOPi�TC.) GAS PIPING <br /> OTHER � EXHAUST FAN <br /> — � _ OTHER <br /> -- — — � — <br /> I HEREBY CERITIFY THAT I HAVE REA�AND EXAMINED T41S APPLICATION AND KNOW THE SAME TO BE TRUE AND COqRECT. AIL. <br /> PROVISIONS OF LAWS AND ORIDINACES GOVCRNING THIS TYPE OF 6.ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �dOT. THE rRANTING OF q pERMIT DOcS NOT PRESUME'i O GIVE AUTHORITY TO VIOLATE OR CANCEL THE HROVISION OF AN'!OTHER <br /> STATE OF LOCAL LAW REGULo?:";G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUG'fION. THAT I AM AUTHORIZED BY THE <br /> OW ER OF THIS PqOPERTY TO PERFORM THE WORK FOF WHICH APPLICATION IS MADE AND I COMPLY WITH THE ST.1TE <br /> CO TRACTORS LAW 18.27flCW A�'D 296200 WAC. <br /> ✓ / �� �r// ''7� <br /> 1 �"" '�'`zL2'�L'{ ,�1�Ii� �~�•�/-_I /�/--��/ <br /> Sign ure of Ow dContracto�/Aufhonzed qgent ��„ <br /> !,// � <br /> �LJ <br /> �� <br /> � <br />