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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 —FAX 425-257-885 <br /> G?J 3��Y.t� <br /> SITE AODRESS 10�?A 1�L-W D1 AN A�� PARCEL TA%I.D.• P RMIT M <br /> ��'C WA 982,�6 •�5 ��� ZG ' <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. 5 O C <br /> OWNER I0�2O ME�ID I�tN�{�� �I�REjT.�NA S� PHONE C <br /> �►+b� tc`t� `{� 9 � � 8�sz <br /> TENANTNAME CONTACTNAME PHONE <br /> cNoNC� �4 `�� I «i�1 �u �� <�2i� 240 8�s� <br /> CONTRACTOR ADDRESS ZIP CONTR.UCENSEN <br /> OWAIi=� <br /> PHONE <br /> PROPOSED USE OF BUILDING 6n Building fi7 MechaniCal 6a Addition HEAT SOURCE <br /> PERM�T �� Combination W� Plumbing WORK K Alterr.tion Electric <br /> TYPE �,+y Demolition LJ Sign IYPE �l New Gas <br /> LJ Sprinkler U Repairlhlaint. Other <br /> CONTRACT PRICE OF WORIS CITV OF EVERETT LOCAL SALES TA%COUE IS 3105 <br /> '[- � o4W <br /> WORK DESCR�PTION ��G` /� ��7 � n J�L/�1�� /i�//�0 7 <br /> v Ci / ��y c � yu% <br /> 1��t- Co�� <br /> �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF fl%TURF.OR ITEM <br /> _j_, WATER CLOSET A/C-A/HANDLING UNIT 7 <br /> � BATHTUB � FORCED AIR SYSTEMS�ttic�t .� , <br /> � LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES ORYER <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRYTRAY � WATER HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIRcPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICFJBAR/MOP/ETC.) Q EXHAUST FAN <br /> OTHER_ ._ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIO��AND KNOW THE SAME TO BE TRUE AND CORPECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS NPE OF WG� .'WILL BE COMPLIED WITH WHETHEii SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFOFMANCE 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 /> CONTRA TOFS I.AW 18.27 RCW AND 296.2C0 WAC. <br /> r.� � �� f— �—aca� <br /> Signature ol Owner/Contractor/Authonzed Agent Date <br />