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P�.r�MIT APPLICATIG�� <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. # P RMIT x <br /> n. .. - - L�' �," � c1Y.1 , �_ <br /> LEGAL LOTNO. BL CK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> TENANTNAME CONTACTNAME PHONE <br /> �v�u�i� �tStr�o�� C'-�c� Wi�.►c��cs Cv2�)r.a+�-zrz� <br /> CONTRACTOR .�'j����� �u�P�-r AODRESS '�,p, �X G5� ZIP CONTR.UCENSE M <br /> �073 {�2f�lcos/t� <br /> PHONE <br /> _�'i�5�[P4 I-�I 2'7 <br /> PROPOSED USE OF BUILOING BUilding t�'MeChanIC31 Addition HEAT SOURCE <br /> I PERMIT g Combin�lion KI�.( Plumhing WORK � Alleration � Electric <br /> TYPE D Demolilion v Sign TYPE New Gas <br /> IU Sprinkler RepaiuA9aint. Otner <br /> i CONTRACT PRICE OF WORK CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> �� ��1; �� <br /> � WORK DESCRIPTION <br /> I �NS?A�l. U�;�jx7 TIRE VRoiL:.i IcN SYSiEJh �eG. 1<IiZNEN N�i) <br /> � <br /> ! PLUMBING MECHANICAL <br /> i <br /> � NO. TYPE OF FIxTJRE OR ITEM NO. TYPE OF FIXTUfiE 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 _ C�OTHES DRYER <br /> DISHWASNcR RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> I URINAL FIREPLACE INSERT <br /> I _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> �� BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE�BAR/MOP.iETC.) _ EXHAUST FAN <br /> OTHER OTHER x�rex2rv �'tR6 <br /> S�CO"�SS+au SYS7�n'f <br /> I HEFEBY CERITIFY',HAT I HAVE F�EAD AND EXA�dINED THIS APPUCATION AND KtdO�V THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROV�SIONS CF L15N5 -1N�ORIDINACES GOVERNING THIS TYPE OF 1VORK WILL BE COMPUEC WITH'.VH�HER SPECIFIED HEREIN OR <br /> � P�JT THE GRAPJTING OF A PEFM1IIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PPGVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUWTING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OW!% -R OF THIS PROPERN TO PEFFORht THE N'ORK FOF WH�CH APPLICATION IS h1ADE AND I COh1PLY WITH THE STATE <br /> GON fRACTOFS LAW 1827 FCW AND 296.200 WAC. <br /> �1,.. "/ �� ,5%7�0� <br /> Signa' re ol O�meuConlractodAulhon?ed Agent Date _), <br /> �/L <br />