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P�.r�MIT APPLICATIG .J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425 257-8810— FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX 1.�.N PERMI7 H <br /> CQ')IS ��ym �����e moadq-o�z <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHON C�?3 �a_53aS <br /> �IS►� c�0��o-lrl 7/,S (7/ w� i �ri�� �'a0 G25 35�07(e� <br /> TENANTNAME I CONTAC NAME PHON <br /> CONTRACTOR A�ORESS ZIP COMfl.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT R Combination R Plumbing WORK R Alteration � Elxtric <br /> TYPE D Demolition � Sign TYPE D New Gas <br /> U Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION R�IQ�.n� �'q`1eb W�er hea�F� �"i"�� haK1 (,UCajP.Y �-a�Y— <br /> I PLUMBING MECHANICAL <br /> I N0. TYPE OF flXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I <br /> WATER CLOSET A/C—A/HAND�ING UNI i S <br /> � _ BATHTUB _ FORCEU AIR SYSTEMS <br /> , _ LAVATORY (WASH BASIN) HEAT PUMP <br /> i _ SHOWER _ UNIT HEATERS <br /> I = KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> � _ LAUNDRY TRAY �, WAT[R HEATER <br /> i _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I 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 OTHEF <br /> I HEFEBY CERITIFY THAT I HAVE READ AND EX.ih11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE HND CORRECT. ALL <br /> PROVISIONS OF L,1WS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIh OR <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> . STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> � OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN�I COMPLY WITH THE STATE <br /> GONTRACT�- 27 RCW AND 296. 0 WAC. <br /> � �� q_zo_d-Z <br /> Sign e ol Ow dConlractor/AWh � � ed Agent Date <br />