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' � � .�ERMIT APPLICA i ��N <br /> CITY C1F EVERETT PERMIT SERV;CES <br /> 320U CEDAR STREET, EVERETT, WA 98201 <br /> �Q� � 425-257-8810- FAX 425-257-8857 <br /> - ��f-- <br /> SITE ADDRESS PAFiCEL TAX I.D.M PERMIT x <br /> $�-� P,�E sr���r ���o���.��� , 2-az� <br /> LEGA LOTNO. BLOCK TPAC7 <br /> oEs°. y G'f aF �l �la�(��-t � Di-oz7 <br /> OWNER <br /> � A ESS ZIP PHONE <br /> �FD OnISC��iUI.To.a I�,Ir � 'Ij.�,� �'i.lr".�.1�.1n1/� .�'D�I ��5�"7(�3 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR�^` Ojv-1f� ADORESS LP CONTq,UCENSE N . �• <br /> �'� Np y <br /> PHONE �LS la O�9CE� <br /> ekP.1�Ts I-3-oq <br /> PFOPOSED USE OF BUILDING Building MechaniCel Addition HEAT SOURCE <br /> PERMIT �Combinalion � piumbing WORK leration I''1 �lectric <br /> �� �11,J 7YPE Demolitlon Sign TypE NeW F.i�a$ <br /> ���J Sprinkler AepairiMaint. U Other <br /> CONTRACT PRICE OF WORK ���y�,_ �/�O/ 7 CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> u.V 7 G <br /> WORK DESCRIPTION ' <br /> CoNsT►�+��T;oN c3F c� ►v��1 Conlsfi��ro�J si�G� �;,� �,p <br /> /L 2/ <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> �L WATER CLOStT /// A/C—A/HANDLINC,UNITS <br /> � BA7HTU8 // T FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) //; _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _L KITCHEN SINK 3 DISPOSAL � CLOTHES DRYER <br /> / DISHWASHER ,� RANGE HOOD <br /> LAUNORY TRAY � WqTER HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN / GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> I _ BACKFLOW PREVENTER '� GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN //�� <br /> _ OTHER _ OTHER <br /> I — <br /> � — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> i PROVISIONS OF LqWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> iNOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUC7'ION OR THE PERFORMANCE OF CONSTRUCTION. TNAT 1 AM AUTHORIZED BY THE <br /> � ON/NER OF THIS PROPERTY TO PERFORM THE W ORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTOR W 182 W qND 296.200 WAC. <br /> � �-� f� 11,GS �Z 23-aZ- <br /> �na ure ol Owner �onh ctoVAuthonzed Agent Oate <br /> i \�Z <br /> \ <br />