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I <br /> • 1 � <br /> PERMIT APPLICATION <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./ <br /> � PER fT <br /> • ks 3 37 3 p� d �3,OC�``� <br /> LEC+A LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS <br /> LP PHONE <br /> TENANTNAME n � C� I CONTACTNAMEa S � � �12'r� <br /> PHONE <br /> CONTRACTOR ApORES� <br /> O4y � IV.�I-C, /GG �y / 3�'� nP CONTRIICENSE� <br /> PH6NE �{ ✓G U �$�37 oa�N� Pff�yy F{ <br /> LS �7y- y <br /> PROPOSED USE OF BUILDING Building �Mechanical <br /> PERMR Combination Plumbi �d� �T�URCE <br /> / TYPE Demolition � �RK �AMaration �E�� <br /> ,J !i:.� y � 5�9� TYPE N� � <br /> Spllnkler epairR.4int. pp�q� <br /> CONTRACT PRICE OF WORK 3 SC� CITY OF EyEqEfT�pCN,g�Eg TAX CODE IS�705 <br /> WORK DESCRIPTION /J �/ <br /> /tP��A �f O��L 1u irc,c e w� 9G% t+ � �.✓ -�'.. .i.acG <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FlXTURE OR fTEM <br /> NO. 7YPE OF FIXTURE OR REM <br /> _ WATERCLOSET A/C-A/HANp�INGUNITS <br /> _ BATHTUB � FORCEO AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HFJ1T PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER <br /> ,_ LAUNDRY TR,qY — �GE HOOD <br /> _ CLOTHES WASHER — WATER HEATER <br /> _ URINAL _ ME7AL FIREPLACE/S70VE <br /> _ DRINKING FOUN7AIN _ FIREPLACE INSERT <br /> _ FLOOR DRAIN _ GAS FIREPLACE <br /> _ BACKFLOW PREVENTER — �S�GE <br /> _ SINK(SERVICE/BAR/MOP/ETC.) — �S PIPING <br /> _ OTHER — �USTFAN <br /> _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ qND EXAMINED T}11S APPLICATION AND KNOW T}�E SAME TO BE 7RUE AND CORRECT. ALL <br /> PROVISIONS OF lAWS AND ORIOINACES GOVERNING THIS TYPE OF WOF,;(yy�LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMR DOES NOT PRESUME TO GNE AUTHORITY TO VIOUITE OR CANCEL THE PROVISION OF qNY OT}iER <br /> STP,TE OR LOCAI UW REGULATING CONSTRUC710N OR THE PERFORMANCE OF CONSTRUCT�ON, THqT�/VdA�7}�pR�D BY TNE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WFIICH APPLICATION IS MADE AND,COMPLY WITH T}{E STATE <br /> CONTRACT 18.27 CW AND�pp WAC. <br /> Sign IUieo�.A%•erl rect AuNonzedAgent �z ate <br />