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� 'ERMIT APPLICAl�.JN -� <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7• <br /> 3 L�J�t �- � S'YY� 'N Z —00}- DO <br /> LEGA LOT NO. BLOCK TRACT <br /> OESC. ,Jwa � �/K�, L <br /> OWNER ADDRESS ZIP PMONE <br /> /yi�� �3e��is... /93L ��i/M /�,e 9"8'iY2 f'Ls-JY� -3s3� <br /> TENANT NAME I CONTACTNAME PHONE <br /> •Ww�.► fw/�C •! ��NG <br /> CONTRACTOR AUDRESS LP CONTR.LJCENSEM <br /> PHONE " <br /> dldN�r �t/��� Y'�'INR/G <br /> PROPOSED U3E OF BUIL�ING Building fl MeChaniCal Addition HEAT SOURCE <br /> PEHMIT �mbination H Plumbing WORK R Alteration � Eiectric <br /> p 1'YPE emolition �� Sign IYPE �� New Ges <br /> /LIM�N� y�G Sprinkler d Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> iWORK DESCRIPTION <br /> �i �CM/NL +p.ti�G •0 �t LIs�O/J� � i�'^ �9 M i' lyJ�DY`A�� <br /> i <br /> d �� <br /> i PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF flKfURE OR ITEM <br /> WATER C�OSET A/C—A/HANDLING UNITS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHE,DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN 6AS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKF�OW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPI�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A�L � <br /> PROVIS�ONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. 1'HE GAANTING OF A PERMIT DOES M1OT PRESUME TO GIVE AUTIIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW iiEGULATING 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 THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature ol Owner/Contractor/Authorized Agent ate � <br />