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P���MIT f�P'PLICATIG. ] <br /> CIT'Y OF EVERETT PERMIT SERVICES <br /> ` 3200 CEDAR STREET, EVEFiETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS ` PARCEL TAX I.D.# PEAMI7 a <br /> ) .�3 � l-� � m oao�-�z <br /> LEGA LOTNO. BLUCK TRACT <br /> DESG ` � <br /> OWNER AODRESS ZIP PHONE � <br /> o ��-�- c �� 3 � �� ��� �J �. n �,� <br /> TENANTN^�h7E ,^� �` �� � _ I I ��1�.`CV� G �CK CP� C1 �'""� <br /> � <br /> VU�—V�`I � Vll <br /> CONTRACTOR � '�\�\S �\n.��\� ADDRESS 21P CONTR.LICENSE M <br /> '�—+l7 <br /> PHONE �O I �� � � c� <br /> �O J �� <br /> PROPOSE�USE OF BL'ILOING �3 Buildi�J � Mechanical `D Addition HEATSOURCE � <br /> ///��� PERM1IIT ��—(( Combinalion Plumbing WORK � Alteration � Electric <br /> ���11 ���� TYpE �j Dem01i!i0n Sign TYPE New Gas <br /> � L� Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK - �� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> \ v�s'�a\l C-� as -�,�r,���c, , !-\o��.��r �1�das�U— c uc��as <br /> ���s �o�c' �a�\ 2� �. �C' Q,Y' <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ fORCED AIR SYSTEMS <br /> I _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> I = SHOWER = UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER AANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLCTHES WASHER __ METAL FIREPLACE/STOVE <br /> URINAL FIREPIACE INSERT <br /> I DFINKING FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SIVK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEFEBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WI�ETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHO4ITY TO VIOLATE OR CANCEL THE PpOVISION OF ANY OTHER <br /> STATE OR L CAL LAW REGU TING CONSTRUCTION OR THE PERrORM11ANCE OF CONSTRUCTION. THAT I AM AUTHORIZEU BY THE <br /> OWNER,OF T IS P PER1Y T PERFORM THE WORK FOR WHICH APPLICATION IS 61ADE AND I COMPLY WITH THE STA?E <br /> CONTfjACT RS LA� 1827�CW D 296200 WAC. � / � r O� <br /> � <br /> Signa ure 1 Owner/Cont acto /Authorized Agent Date <br />