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P�,�riMIT AP�'�LICATIG�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S7REET, EVERETT, WA 98201 <br /> 425-257•8810 - FAX 425-257-8857 <br /> SITE AD��O / �� PARCEL TAX I.D.N PERMIT k <br /> OC. t'azo3-o GZ- <br /> LEGA LOT NO. _ / ,� BLOCK TRACT <br /> DESC. ��O/ O�UV -�- <br /> OWNER ADORESS ZJP PHONE <br /> C,� of �V 3,io� Ged �,r,� �o, C�2s�?s�-�-� <br /> TENANT A E CONTACTNAME PHONE <br /> O /� /�5 �/ I �o� �Pv1S�n CYzr�zs'7-S�'�� <br /> CONTRACTOR�m m � � I��ADORESS ZIP CONTR.LICENSE N <br /> (d�N(�I' <br /> PHONE <br /> S7�itn�u , G[� <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> I PERMIT � Combination � Plumhing WORK� Alteralion � Electric <br /> TYPE Demolition Sign TYPE New Ges <br /> Sprinkler FapaidMaint. O�her <br /> CONTRACT PRICE OF WORK CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> �� WORK OESCRIPTION ���� � �� y�� d�� �U � Q�j� <br /> i�•� W uv <br /> IPLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR REM N0. TYPE OF Fl%TURE OR ITEM <br /> 1 <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> � _ BATHTUB _ FORCED AIR SYSTEMS <br /> i _ �VATORY(WASH BASIN) _ HEAT PUMP <br /> � _ SHOWER _ UNIT HEATERS <br /> , KITCHEN SINK 8 DISPOSAL CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> ; LAUNDRY TRAY WATER HEATER <br /> i CLOTHES WASHER METAL FIREPL4CE/STOVE <br /> i _ URINAL FIREPLACE INSERT <br /> � DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR �RAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SiNK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _� OTn D, �,���,�� _ OTHER <br /> 17 <br /> —I <br /> �HEFEBV CERITIFY'HAT I HAVE READ AND EXA1.71NED THIS APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF W WS A�lD ORIDINaCES GOVERNING THIS TYPE OF WORK W�LL BE COMPLIED WITH WHETHER SPECIPIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATc OR LOCAI LAW REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCT�ON. THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPERTY TO PEFFORh1 THE'NORK FOF WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRAC RS LAW 18.27 RCW AND 296.200 WAC. <br /> .3 $' D Z <br /> Signalure ol OwneuCo raclodAuthorized Agent ate <br />