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� � <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.If PERMIT M <br /> (o I(-�-s �4�- a OZO/ ' <br /> LE6A LOTNO. ��S BLOCK TRACT <br /> OESC. _� � �( <br /> OWNBR ADDRESS aP PMONE <br /> �A��l � .� .�blq op�� � ��i �Ya5z.sz � <br /> TENANTNAME I COHTACTNANE PHONE <br /> SAHc.e- <br /> CONTRACTOR JlA�� ADDRE53 LP CONTR.UCENSE• <br /> PHONE �15 �Z_p,�� <br /> 9" <br /> PROPOSED USE OF BUILDING Building � Mechanical Audition HEAT SOURCE <br /> PERMIT Combination Plumbing WORK Alteration Q Electric <br /> �� ) � TYPE Demolilion Sign TYPE New u Gas <br /> / Sprtnkler RepeidMeirn. U Omer <br /> CONTRACT PRICE OF WORK CRY OF EVERETT LOCAL SALES TA%CODE IS�106 <br /> WORK DESCRIPTON ^ �^ ' � , <br /> �e ti;_�T.+ut <br /> PLUMBING MECHANICAL <br /> ' NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> �AVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYEr� <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ METAI FIREPLACEJSTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAtN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPIN(i <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY TNAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF UIWS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfFtER SPECIFIED HEREIti OH <br /> NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL U1W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC ORS LAW 18 RCW AND 296.200 WAC. <br /> � �` <br /> Sign u e ol wner/Contractod uthorized Agent ate <br />