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PL�MIT APPLICATIO�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEI TAX I.D.N PERMI7 a <br /> o - ' �ir�^o�- o�� <br /> , ;e.� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWN�� �_ AOORESS ZIP PHONE <br /> ` ` .� Av� c�Cn� � ���C� L. r• ✓: �U L L 2S �- <br /> TEN�NAME CONTACTNAME PHONE <br /> - liw� ���� � �,Mu l�� (�t (w� C-t�l�.t �YZs,� 75��-3or� <br /> CONTRACTOR ADDflESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OP BUILUING Building �MeChanical Addition HEAT SOURCE <br /> PEpMIT R Combinalion Plumbing WORK�Alleralion �Electric <br /> � TYPE D Demolilion Sign TYPE New Ges <br /> U Sprinkler Repair/Maint Other <br /> CON7RACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION P1 �� ��� ��o� ���J, ;N� 1 J _ n ' <br /> v V V� �6�•• <br /> PLU�BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A!C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 GSPOSAL CIOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METALFIREPLACE/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 /> OTHEF OTHER <br /> I HEREBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br /> PAOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER 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 REGULATI G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS W 1 27 RC 296200 WAC. <br /> 815`b� <br /> Signature ol Owner/ContractorlA orized Agent Date <br />