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; <br /> �E�I�lll�' �4PPLICA`�ION � <br /> � CITY OF EVEF�ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> c� �zpr-o�3 <br /> SITE AD�RESS C a- e r`p '2! E e"'u�� pARCEL TAX I.D.# PERMI7 a <br /> no ll �� ue, 3 <br /> LEGA �OTNO. BLOCK THACT <br /> �ESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 1�)GC��i �T�C SC/ioo( U�S� 9�A� a-f'1.4�o.-t ��p 9rY�a9 3�G-/ 2vo <br /> 7ENANTNAME I CONTACTPdAME PHONE <br /> I CONTRACTOR Q��n Q.�� AD�RESS ZIP CONTR.LICENSE q <br /> PHONE <br /> PROPOSED USE OF BUILOING I BUildiflg Mechanical Q Addi�ion HEAT SOURCE <br /> 5���i PERh71T R Combina�ion � Plum6ing IV.:!1K �_) Alteralion � Electric <br /> TYPE � Demolition Sign TYPE D New Gas <br /> Sprinkler U Repair;Mainl. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> WORKDESCRIPTION ff-b�� y�s C2E<<��, "�'�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUFE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET A/C—A/HANDIING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWEA _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY ^ WATER HEATER <br /> _ CLqTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRIMKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ 9ACKFLOW PREVENTER GAS PIPING ;� <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN � <br /> � � UTHER L'�2[aSe- `�2d.� _ OTHER i , <br /> � _ <br /> I HEREBY CcRITIFY 7HAT I HAVE READ AND EXAMINED THIS APP�ICATION AND ICNOW THE SAME TO BE i F1UE AND COFRECT. ALL ' <br /> PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1YPE OF WORK WILL BE COMPLIED WITH WH!_�THER SPECIFIED HEREIN OR - � <br /> NOT. iHE GRANTMG OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER �•"1 <br /> STATE OR LOCAL LAW qEGULATING CONSTRUCTION Ofl THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE Y-' <br /> OWNER OF THIS PROPERN TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 AGW AND�96. 00 WAC. <br /> ��--� ���, i- o -�� <br /> Signalure ol Owner/Conlractor/Authonz Agent Date � <br /> � <br />