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PE. �MIT APPLICATIO. � <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.a PEah7tT n <br /> �.��� c�,�,.s ��„r o�K3�, � .�3 �, � � ��� iav� - oa3 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ����� �ctt�-cr_Gb�2 'L�'�-t c�a�� ��r �i43�Lot �zs" zs��l � z�+ <br /> TENANTNAME <br /> CONTACTNAME PHONE <br /> S R �k 5 r'� f� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEk <br /> PHONE ��µr <br /> PROPOSED USE OF BUILDING Building Q Mechanical [� Addition NEAT SOURCE <br /> PERMIT Combination u Plumbing WORK �Alteralion � Electric <br /> �� n��p�,c. TYPE Demolilion U Sign TYPE New Gas <br /> �� Sprinkler fiepaidh7aint. �NOM Other <br /> CONTRACT PRICE OF WORK G,-! � �l` Q7(J) CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �� - � ��..� <br /> WORK DESCRIPTION <br /> {\�tPt(� �-ic r.) �..�1'[�C L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ NC—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 /> I CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> , _ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> i FLOOR DRAIN _ GAS RANGE <br /> � _ BACKFLOW PFEVENTER _ GAS PIPING <br /> SINK(SEFVICE.�BAR/MOPlETC.) _ EXHAUST FAN <br /> � OTHER _ OTHER <br /> I HEFEB'I CERITIFY THAT I HAVE READ AND EXA611NED THIS APPLICATION AND KN06V THE SA61E TO BE TRUE FND CORRECT. ALL <br /> PROVISIONS OF L11W5 AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEFEIN OF <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STATE OF7 LOCAL LAW REGjJLATWG CONSTRUGTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED BV THE <br /> ' OWNER OF THIS PROPERTf TO PEQFORM THE WORK FOR VlHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> GONTRACTORS LAW 1827 FiCW A(D 296.200 WAC. <br /> � - � ' _ �"i'�� � f U � L— <br /> !" . <br /> � SignaWre ol CwneNContractoUAulhorized Agent Dale . I/ <br /> /Z <br />