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P RMIT APPLICATIO�N <br /> CITY OF FVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.N PE IT k <br /> C���i � S� 9'3�7/ 3C� -G�13 <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS PHONE <br /> 1� i�`G`� '� i �O � � t� S� C(�'3�i �cfii9 <br /> TENANT NAME I CON�CT NAME PHONE <br /> (`I�. S � <br /> C�uT�C�'pp ADDRESS CONTR. LICENSE N <br /> d�C. �' I <br /> PHONE <br /> PROPOSED USE OF BUILDING ("') Build(ng � Mechanical Addition HEAT SOURCE <br /> PERMIT n Combination Plumbing WORK � Aitarauon D Etectric <br /> TYPE �� Demolition Sign TYPE New D Ges <br /> D Sprinkler RepairlMaint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3t05 <br /> WORK DESCRIPTION (� ln/; ��p �j� �Y �'F �� G�� � U �tJYI ne,�J <br /> l./7 1� � ��- <br /> �LUMBING MECHANICAL <br /> Np, TYPE OF fl%TURE OR REM N0. TYPE OF FlXTURE OR REM <br /> WATERCLOSET _ A!C-A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEPEBY CERITIFY THAT 1 HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVIS�ONS OF LAWS AND ORIDINACES GOVERN�NG THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAL U1W REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �-�l'� ���3�a � <br /> Signature of OwnedContractodAuthorized Agent Date <br />