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PcRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M • pM17 K � / <br /> �,- oos93� �9so 00 � �fl= �!( <br /> LEGA LOT N0. BqLOCK TRACT n 1 l <br /> DESC. I�J ` I� � I 5 W Q.IIS (�v-Q �1'�lIIv� 'FD <br /> OWNER ADDRESS � ZIP PHONE <br /> ��c ��R�Ns�N 23 �Zs � Is� c1v, sE. wa�buv��.� 9�o�-z yLsB� <br /> TENANTNAME I CONTACTNAME PHONE <br /> 5�.�.,..n_ acs OU.rno� C)WV�a-� �FL�—g70-6o(oR <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N � <br /> PHONE �Q � g <br /> C)W,��' <br /> PROPOSED USE OF BUILDING Building f� Mechanical Addition HEAT SOURCE <br /> PERMIT � Combination K Plum6ing WORK R Alteretion � Etectric <br /> TYPE Demolilion LJ Sign IYPE D New Gas <br /> �` Sprinkler U RepaidMaint. Other <br /> CONTRACT PRI E OF WORK CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION / - \� a OC(� <br /> WO-CJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF Fl%TURE OR ITEM � <br /> WATER CLOSET A/C-A/HANDLING 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 _ METALFIREPIACE/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 /> i = OTHER = OTHER <br /> I HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICf,TION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE AUTHORIT'TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOFi WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ���i���.. S�Y-o z <br /> Sic� ure ol OwnedContracror/Authorized Agent Dale <br />