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� <br /> PERIV�IT APPLICATION <br /> � ' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8(i10- FAX 425-257-8857 <br /> SITE ADDRESS I PARCEL TAX I.D.8 PERMIT# <br /> 3 �l� LD�M1�0.rf� 1�v�Q O� y � °/ Q 1,1 DO � fc �UI/Q—(� �-� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS <br /> � 1 PHONE <br /> L�1 LQ �� 0.� � '3 l l P La�n.t)arpl �Q� a r 3 - 3 �a - s S ts <br /> TENANT NAME CONTACT NAME <br /> N�`� I , �,�� n�- V PHONE <br /> ��' �t I 20 6 - t f 1 -'11-u � <br /> CONTRACTOR ADDRESS <br /> (� � S f V I CON7R. LICENSE N <br /> PHONE •�- Y�' � ""`�+�--�� lCy V4�.o <br /> zo to - �- S L - `-�'> o n S'��S�-P.�� �.,.4 SI-� y 5 wf'r S M F ES 9 S{AC <br /> PROPOSED USE OF BUILDING Building � Mechanical Addition HEAT SOURCE <br /> PERMIT � Combination Piumbing WORK. �Aperetion eloctric <br /> S F R TYPE Demolition Sign TYPE New Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK S C' D � � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIP7'ION <br /> t n"'7Q o � .5 `-s 'l� 5. �1 l�. '(- w > ��'r 1na5,� v <br /> PLUMBING MECHANICAL <br /> NO• TYPE OF FIXTURE OR�TEM NO. TYpE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ A/C�-A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHCN SINK& DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> __ LAUNDRY TRAY � WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INuERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTEH _ GAS PIPING <br /> _ SINK(SEFVICE/BAWMOP/ETC.) _ EXHAUST FAN <br /> _ OTHER <br /> _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COARECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 7YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRqNTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLRTE OR CANCEL THE?ROVISfON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 7HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO pERFORM THE WOHK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 2g6200 WAC. <br /> G ��., ._- _ A.'F� �°/ <br /> Si e re o!OwnodConiractodAuthonzed-Agent Date - <br />