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C ERMIT APPLICAT��N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAN STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � <br /> SITE ADD PARCEL TAX I.O.A P RMiT M <br /> `P e. � �10�1.39r�(�93bSa� I �oa ► a-fla�� <br /> IEGAL LOTNO. BLGCK TRACT <br /> DESC. <br /> OWNER AOURESS LP PMONE <br /> C�1 a k' F��.e.�-- �Qitrd�n,�� 3�Gda✓�- �8�� �'�-as�--8�4 0 <br /> TENANT E I ONTACTNAME PHONE <br /> CONTRACTOR �� ��,,,i„u,,,,f�l'� qDDRESS�,(I.n., �A �� ZIP CONTR.LICENSEN <br /> /(3'I�INlI�I ��' D /�bt '` <br /> VHONE �Vj.�� I J�,,,, � � T1�iCAI�I.Otl��T <br /> ��y��� � � C� <br /> PROPOSED USE OP BUILDING Building Mechanicat Addition MEAT SOURCE <br /> PERMIT Combinetion RI..( Plumbing WORK RI.�1 Alteration Electric <br /> TYPE Demolition u Sign TYPE u New �R{ Gas <br /> Sprinkter U RepairiMaint. U Other <br /> CONTHACT PRICE OF WORK I�Zf� q� CITY OF EVERETT LOCAL SALES TAX COOE IS]105 <br /> ,/VU I J <br /> WORK DESCRIPTION ��O (L,n„ O,C a ���y� <br /> `\UY 1 <br /> PLUMBING <br /> MECHANICAL <br /> I N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF flXTURE OR ITEM <br /> __ WATER CLOSET _ A�C—lUHANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BAS�N) _ HEAT PUMP <br /> _ SHOWCR _, UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> � _ CLOTHES WASHER _ METAI.FIREPLACE/STOVE <br /> _ URINAL _ FIREPL4CE INSERT <br /> _ DFINKING FOUNTAIN _ GAS FIREPI.ACE <br /> i _ FLOOR DRAIN _ GPS RANGE <br /> i _ BACKFLOW PfiEVENTFR _ GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFV'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TU BE TRUE ANO COHRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITI1 WlIFTHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAN�=L THE PHOVISION OF ANY OTHER <br /> STATE F LOCAL LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTqUC110N. THAT I AM AUTHORIZED BY THE <br /> OWN OF THIS PROPERN TO PERFORM THE WORK FOR WHICN APPLI ATION IS MADE AND I COMPLY WI7H THE STATE <br /> CON C70R5 .27 RCW AND 296.200 WAC. <br /> - �a �s o1- <br /> Sig atu;�o r! tractovAuthonzetl Agent Dat <br />