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P�.3MIT APPLICATIC _ J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88?0- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.• PERMIT M <br /> � �,-�- nw �l� 6 � <br /> LEOA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE S aP PMONE <br /> TENANT NAME . CONTACT NAME PHONE <br /> Ucsc-�c.s �«.�,a,c,� � i�� T/�� (s�s� �sr- se�o <br /> CONTRACTOR D E39 21P CONTR.LICENSE M <br /> Eu�i �zs 4�- t� 2(zo �� fl�e qea�t <br /> PHON � _ (( EU� ��Z�T <br /> PROPOSED USE OF BUILDING BUild(ng w7 mecne�iCel Addllbn HEAT SOURCE <br /> PERMI'i Combination H Plumbing WORK Alteretbn eclric <br /> �� � TYPE � Demalilion L� Sign TYPE New �. �Ou <br /> Sprinkler RepeiriAAeint. U Omer <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS]106 <br /> WORKDESCRIPTON 'T}� �a�T �p����T� �� �v � <br /> l�. J <br /> �lbkt � �NSirlt,L �04� ��Sutifc � <br /> iPLUMBING MECHANICAL <br /> NO. 7YPE OF FlXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> ' NATER CLOSET _ A/C—AMANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> � = LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> � _ DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAI FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN _, OAS FIREPLACE <br /> � FLOOR DRAIN _ OAS FANQE <br /> i _ BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE78AR/MOPlETC.) _ EXHAUST FAN <br /> OTHER O HER <br /> I -I . <br /> i I NEREBV CERITIFY 7HAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br /> � PROVISI01�5 OF U1WS AND OiiIDINACES GOVEFiNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SFECIFIED HEREIN OR <br /> NOT, THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AJTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE Oii LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIZED BY THE <br /> OWPIER UF THIS PROPERN T RFORM TNE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITM THE STATE <br /> :ONTRA O . LAW 1827 CW A� /D?�,,6.200 WAC. <br /> �'w � '2� ��� <br /> Signalure of OwneU onlractor/Authorized Agenl ate <br />