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( <br /> PERMIT APPLICATION <br /> CITY OF EVERET7 PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADORESS ��0� ����G PARCEL TAJ(I.D.R PERMIT M <br /> c�Z/o'�IC� <br /> LEGA LOT NO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS <br /> ZIP PHONE <br /> L;��.e� ��a� a�o,�� �c 9�ao� .s� _ <br /> TENANTNAME I CONTACTNAME <br /> PHONE <br /> CONTRACTOR �� . i/__ L •_ qDDRESS /�,16i��� �_], _.„�p CONTR.UCENSE 1 <br /> �tlC1K!!'�Y� `r,�•�r.� <br /> PHONE O �� LL�i, q�aa,� DEPE.i/f/190/L <br /> y�,s=as9- �9i�' <br /> PROPOSED USE OF BUILDING Building Mea�anical Addilion HEAT SOURCE <br /> �J1 PERMIT B Combination � Plumbing WORK �Alteraiion E�ectr�c <br /> � K TVPE D Demolition � Sign 7YPE D laew Gas <br /> U .`',prinkler U qepair/Mainl. OMer <br /> CONTRACT PRICE OF WORK�?l ar.� . CITV OF EVERETT LOCAL SALES TAX COGE IS 3105 <br /> �-l7 <br /> WORK QESCRIPTION <br /> �k.f�2ea� Q,nc�.t�f.et�-�_ �r�t�.�.� <br /> U ' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE 0,9 REM N0. TYPE OF FlXTURE OR REM <br /> ___ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _J__ FORCED AIR SYSTEMS <br /> _ l.4VATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSP.L �_ CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> _ CL07HES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL � FIREPLACE INSERT <br /> ._ DRINKING FOUNTAIN � OAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKF�OW PFiEVENTER � GAS PIPING <br /> _ SINK(SERVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER <br /> _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED WITH WNETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PReSUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR IOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br /> OWNER OF 7 S PR PER�FORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRA O S 78. RCW D 296.200 WAC. <br /> �D-�y oz <br /> Signature I Owner/Conlractor/Aulhorized Agent e�e <br /> I �p�(0 0�(Q <br />