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P�h�MIT APPLICATIOIV <br />�, � CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W/'. 98201, 425-257-8810 <br />SITE A�DRESS <br />3� ��- <br />LEGAL LOTI <br />DESC. <br />OWNER <br />M,��� <br />TENANT NAME <br />CONTRACTOR <br />PHONE <br />PARCEL TAX I.D. q <br />� 431�,9 �'29027Dd <br />ADDRESS <br />CONTACT <br />ADDRESS <br />PERMIT # <br />, .� - <br />H E <br />�i}S <br />�q-se1s <br />PHONE <br />CONTR. LICENSE # <br />PROPOSED USE OF BUILDING Buiiding � Mechanical Addition HEAT SOURCE <br />PERMIT R Combination Plumbing WORK R Aitera�ion � Eiectric <br />TYF'E D Demolitian Sign TYPE D New Gas <br />U Sprinkler U Repair/Maint. Other <br />CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX COCE IS 3105 <br />WORKDESCFiIPTIONQi (�,n.,� -�-�„�o non-�cr.c+l �'rir�� wo���s <br />l!i, 1/�S.w�iC (i�� G�T�Tcr.Of� `^Jr^�. \�S ,C�j���'M'� <br />�.J <br />N0. I NPE OF FIXi URE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITChIEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />/ <br />� <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C —,VHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLAC� <br />GAS RANGE n%�nts+�� <br />GAS PIPING <br />EXHAUST FAN <br />.3� � <br />I HEHEBY CERITIFY THAT I HAVE READ AND EaA611NED THIS APPUCATION AND KNOW THE SAM19E TO BE TRUe AND CORRECT. ALL <br />PROVISIONS OP L1LVS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COM11PLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRA,VTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHOPITY TO \'IOI.ATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL L1�V REGULITING CGVSTRUCTION OR THE PEPFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY T ORh1 THE WORK FOR WHICH APPLICA'iION IS h1ADE AND I COh1PLY WITH Th!E STATE <br />CON� S LA � W AND AC. <br />c C�%�� , � �P q/�o �o i <br />Signature of Owner/ComractodAuthonzed Agent Date I/a <br />