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�. ERMIT APPLICAT �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 — FAX 425-257-8857 <br /> SITE ADDRESS C PARCEL TAX 1.D.N PERMI7 H <br /> oZ 1 �CcG��I� , D �a�a-�o� <br /> LEGA LOiNO. BLOCK TRACT <br /> DESC. <br /> OWNER � � ^ A�RESS ���� ZIP � P��-���-�� <br /> 1�� 1�y)A <br /> TENANT NA CONTACi��ME �HONE�� <br /> �s M � <br /> CONTR/tGj� n^ ��n��n,�,�N�,�� l/t�. ADDROES$�M ��� ��y�� LP CONT�LICENSEN <br /> v� r, � �� �iP�111 fF '�L r ���„ ti� �L�S T4i�cN,�6�, <br /> r�_ <br /> PHONE ���^�� <br /> PROPOSEO USE OF BUILDING Building f, Mechnnical Addition HFAT SOURCE <br /> PERMIT � Combinalion K Plumbing WORK R Alteration � Electric <br /> TYPE !�1–c���emolilion LJ Sign TYPE D New Gas <br /> V Sprinkler U Repair/Maint. Other <br /> CONTRACT PqICE OF WORK I 33� �� CITV OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION ���� �(C � �^n'^D� <br /> �.�.," <br /> I <br /> � PLUMBING MECHANfCAL <br /> ��. NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C–A/HANDIING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATOrIY(WASH BASIN) _ HEAT PUMP <br /> SHOWEfl _ UNIT HEATERS <br /> KITCHEN c INK 8 DISPOSAL CLGTHES DRYER <br /> DISHWAS,IER RANGE HOOD <br /> LAUNDR','TRAY WATER HEAT[R <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 j <br /> I <br /> — — I <br /> _ _ I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED 1�HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. i�LL <br /> PROVISIONS OF L1WS AND ORIDINACES GOVEANING ThiS TYPE OF WORK WILL BE COMPLIED WITH�NHEfHER SPECIFIED HEREIN OR <br /> �OT. THE GRAN'i ING OF A PERMIT DOES NOT PRESUME i:V G�VE AUTHORITY TO VIOLATE OP CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR �!iE P�RFORMANCE OF CONSTRUCTICN. THAT I AM AUTHORIZED BY TF1E <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIChi APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT ACT 5 LAW 18.27 RCW AND 296.200 WAC. <br /> �2 �z <br /> Signature o�OwneriConiractoUAulhorized Agent Gat <br />