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� P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> S�9oDES'PRUfIL U6 ?�02905 I� -�oo �R�ac 3-00 . <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � Q��X ,�..T PHONE �a�'�'7� <br /> TENANT NAINE CONTACT /UAE O E <br /> M60RL Ar eV n °►' �-as -os�8 <br /> CONTRACTOR ���sY��� ADDRESS Q� $�X ��,9 CONTR.UCENSE• <br /> PHONE '-A ^ �'�16Vfi�VVk �'�u',�2'TZ� <br /> �1�������� 1� <br /> PROPOSED USE OF BUILDINa ffiBuilding � Mechanicel Addition HEAT SOURCE <br /> PERMIT 1� Combinetion Plumbing WORK � Alteratbn ,Q Electric <br /> TYPE [� Demolition Sign TYPE New 2L�Gas <br /> U Sprinklef Repair/Mainl. 13 Other <br /> CONTRACT PRICE OF WORK �j O0 OOQ.Q� GTY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> WORK DESCRIPTION <br /> "rYr.NMJt IMP'RdV��T1,T �OR M�tU4L U.IN1lG C4iOT 2 SQ.FT� <br /> ()1�1 '[1� 5�N�► �I.Cb� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> WATERCLOSET _ NC—A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> OISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHEfl METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPIN(i <br /> SINK(SERVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CER�TIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAlAE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TVPE OF WOHK WILL BE COMPLIED WITH WHEifiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TME STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> . <br /> _� , �IL <br /> Sign Owner/Contract uthonzed Agent Date <br /> lo � � `a�/ <br />