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r <br /> ___i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT u <br /> � v xa3o -o <br /> L�GA LOT N . BLOCK TRACT <br /> DESC. <br /> _ NE � AD�55 / �P P ON�/Z� _�� <br /> � y � <br /> .�L <br /> fiNANT NA E . CONTACT NAME PHON �. <br /> ' yP.s 1�I��� �"W� �'�" ���a-i77 � <br /> � <br /> COYTRACTOR ADDRESS ZIP CONTR.LICENSE B . <br /> PHCKE ; <br /> PROPOSEO USE OF BUILDING BUilding r1 MeChaniCal Addilion HEAT SOURCE <br /> PERMIT Combination F�-a��mbing WORK R�.( Alteration R Elect�nc <br /> ��/'1 TYPE � Demolition �) Sign TYPE �j New �-@a� <br /> `� Sprinkler(N of heads) U Repair/MainL L� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIpTION • � ,/ I� <br /> �� /7 /I-Ar/ ///y/��/ // //�,MM�/ /�/jJ�N /L��/��0 � yj /[J(��( II <br /> [�1/" !" "V/`Z/ 'i i/ �(/Vm�l�'^"�'J /�/LC . / //� y�4'[/'��`" �i'��1�� GlN Y I <br /> / / Li <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM � <br /> WATER CLOSET(TOILEi) A/C—A/HANDLING UNITS <br /> / BATHTUB _ FORCED AIR SYSTEMS <br /> VATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS I <br /> ITCHEN SINK 8 DISPOSAL ES DRYER <br /> I DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> LOTHES WASHER METAL FIREPLACE/STOVE <br /> / URINAL FIREPLACEINSERT <br /> _L DRINKING FOUNTAIN , GAS FIREPLACE <br /> � FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVEIVTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER �iTHER <br /> I HEflEBY CERITIFY THAT 1 HAVE READ A�iD EXI�MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LO REGULATING CONSTRUCTION OR THE PERf=ORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE THIS PRO EATY TO PERF RM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C RACTORSLA 82 R AN 96200 WAC. <br /> . <br /> - /-L�- CJ �- <br /> Signa ure o ned m rodA orized Age Date <br />