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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> Sn�/ �Esl.� C�L4lri C��R��'/TAX I.D.�(.// .ni R�� (�/n <br /> G 7 �� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER f����`�t. ��IU/C �.�«•���f��,S ADDRESS ZIP P40NE <br /> i�,�/ .�YzS �o%[�f�ve �2c:� f�-t 9�2�"/ �z�=2s�-�nni <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR �C� �U��'��`�-�Vi1 ADOFSESS LP CONTR.LICENSE� <br /> sc',rv�u: ��� �n L (54c�s-5�. 3 7'r,^p��'/� S�'-2G0 �C1C.C:�S T 0 99 N lc� <br /> PNONE ��S' T5"T � O��L�r �'-� �E=�ii.l�' 7dL���(G' <br /> PROPOSED USE OF BUILDING BUilding I� MecheniCel Addition HEAT SOURCE <br /> PERMIT B Combination �-� Plumbing WORK R Alteratfon � Eieclric <br /> 7YPE Demolition � � <br /> g � Sign TYPE D New Gas <br /> Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVEHETT LOCAL SALES TAX CODE�S 3105 <br /> WORK DESCRIPTION . <br /> �f�-,�-1► �l� R��� ��a��,j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF Fl1(TURE OR R'EM <br /> _ WATER CLOSET A/C—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 /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> � _ URINAL FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> iI1 HEREBY CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEtiEIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROV:SION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br /> iOWNER OF THIS PROPEHTY TO PERFORM THE WORK FOq WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SignaWre of Owner/Conlractor/Authorized Agent Date � ✓ <br /> � <br />