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i - <br /> ��FRMIT APPLICA�`�JN <br /> I � _ CITY OF EVERETT PERIVIIT SERVI;ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425457-8810- FAX 425-257-8857 <br /> SITE ApDRESS PARCEL TAX I.D.# <br /> [� � PERMIT a <br /> / 1J �ZO —� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS <br /> ZIP PHONE <br /> - � lg/,4���r� �Cyd y �la �t�� r,- 9��20� 3/���v�/ i <br /> TEN//i Nqh7E I CUNTACT NAME PHONE <br /> CONTFf1CTOR ADDqESS <br /> Z�P CONTR.LICENSE# <br /> PHONE <br /> PROPOSED USE OF BUILOING I Buildin <br /> 9 Mechanical Addiiion HEATSOUqCE <br /> PEqMiT � Combination � plumbing WORK R�J Alteralion <br /> TYPE Demolilion Sign TYpE u New I Q Electric <br /> I Sprinkler U Aepair/tdaim. L� Other <br /> CONTRACT PflICE OF WORK CITY OF EVERETT�OCAL SALES TAX CO�E IS 3705 <br /> I WOqK�ESCRIPTION <br /> / <br /> �/'on�;:,� �?om� <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> 1J�• TYPE OF FIXTURE OR I7EM <br /> � _ WATER CLOSET <br /> _ BATHTUB — aC—FVHqNDLINGI�NITS <br /> � _ LAVATORY(WASH BASIN) _ FORCED AIR SYSTEMS <br /> _ SHOV�lER _ HEAT PUMP <br /> _ KITCHEN SINK 8 DISPOSAL —. UNIT HEATERS <br /> � DISHWASHER ._ CLOi'HES DRYER <br /> _ Ll+UNDRY TRAY _ RANGE HOOD <br /> _ C' �THES WASHER — WATER HEATER <br /> _. URINAL � METAL FIREPLACE/STOVE <br /> _ DRINKINfi FOUNTAIN _ FIREPLACE INSERT <br /> _ FLOOR �RAIN ' _ GAS FIREPLACE <br /> _ BACKFLOW PREVENTER _ GAS RANGE <br /> _ SINK (SERVICE/BqR/MOP/ETC.) — GAS PIPING <br /> _ OTHER _ EXHAUST F.4N <br /> _ OTHER <br /> ---__. <br /> I HEREP,Y CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE T(iUE AND CORAECT. ALL <br /> PROV!SIONS OF(.AWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL 8E COMPLIED WITH WHF"HEP.SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN 70 VIOLATE OR CANGEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW qEGULATING CONSTqUCTION OR THE PEPFORMANCE OF CONSTRUCTIOIJ. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOqK FOR WHICH APPLICATION IS�dADE AND I COAIPLY'WITH THE STATE <br /> CONTRACTORS LAW 1827 RC'N.1ND 296.200 WAC. <br /> SignaWre ol Ownei/CcntractodAuthorized Agent Date <br />