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PL,�MIT APPLICATIGI►� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORES PARCEL TAX I.D.A PERMIT w <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP pF1pNE <br /> � <br /> TE NTNAME t •1'-' <br /> I CONTACTNAME PHONE <br /> Q.o abo�e <br /> CONTRACTOR ADDRESS ZIP CONTR.IJCENSE M <br /> PHONE a W �e� <br /> PROPOSED USE OF BUILDING BUilding MeChenical Addition HEAT SOURCE <br /> Q PERMIT Combination R Plumbing WORK R AlleraUon I7 Electric <br /> 5 P1 \ TYPE Demolition ❑ Sign TYPE g New ����t ��eg <br /> Sprinkler qepaiqMaint. yc�nher <br /> CONTRACT PqICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCAIPTON <br /> see��n �erm�+ �� a ce.v����ed (� �,�oodstave , ,n�ta.l afio <br /> u Lbug�as �,1� �e" rnocl�.l s 13� � <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTUqE OR ITEM <br /> _ WATER CLOSET A/C—AIHANDLING UNITS <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 /> i _ DRINK�NG FOUNTAIN _ GAS FIREPLACE <br /> � _ FLOOR DRAIN _ GAS RANGE <br /> ; _ BACKFLOW PREVENTER _ GAS PIPING <br /> ' _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> i = OTHER _ OTHER <br /> ve <br /> , <br /> , — <br /> , — — <br /> � I HEREBY CER�TIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OR�DINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THI PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> i CO TR W 18 7 W AND 29620D WAC. <br /> I � <br /> I Signa ure of eU rac odAuthorized Agenl a e <br />