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� ' F�RMIT APPLICATIvN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•881 U - FAX 425-257-8857 <br /> In� �b�o 'O �j <br /> SITE ADDRESS ARCEL TAX I.D.N PERMIT M <br /> I �i.l�� �. ��c�a,rlo v;c�,)1� t. Lf_'x�� ��9 c2�� G�oo? (��pG� -0/3 <br /> LEGA LOT N0. BLOCK TRACT <br /> oesc. � SN +f <br /> OWNER U I ' (x�j <br /> ` A�DqESS ZIP p ONE <br /> Z_�f'i'l P/f1t1 r� T 2 - . , yl� ��i �i G� <br /> �.� L. l�1Jil:'J /�x�r' ilc� .e' ��/ lK �1. ✓�.�� �,� :�- <br /> TENANTNAME CONTACTNAME PHONE <br /> � 1 <br /> ���� a .,.� � F•� :��..,r � a r.,�_ . U�� G�ao �I �/1 r f� 5 c� �v� <br /> CONTqACTOR ADORESS ZIP CONTq,LIC[NSE N <br /> PHONE �JQC A R ��1 ��✓L/ <br /> PROPOSED US�E.OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> � ?� (c^(� tl� ; �- (Z PERMIT R Combinatian � Plumbing WORK � A�teraiion Electric <br /> TYPE D Demolition Sign TYPE New Gas <br /> D Sprinkle� Repair/Meinl. O�her <br /> CONTRACT PRICE OF WORK M� �,,U CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> '( <br /> WORK DESCRIPTION <br /> Lii,'.� r� �� �.rC.iJ � Z :.. r�,�, ./ .S �"'2 . <br /> � <br /> ��� �� <br /> PLUMBING ECHANICAL <br /> NO. TYPG OF FlXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> �� WATER CLOSET _ A/C -A/HANDLING UNITS <br /> � BATHTUB _L FORCED AIR SYSTEMS <br /> ,'�_ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> I _ KITCHEN SINK 8 DISPOSAL .� CLOTHES DRYER <br /> �_ DISHWASHER _L RANGE HOOD <br /> LAUNDRY TRAY _� WqTER HEATER <br /> � CLOTHES WASHER _ METALFIREPLACFJSTOVE <br /> _ URINAL FIREPLACE INSERT <br /> i _ DRINKING FOUNTAIN 1 GAS FIREPLACE - <br /> _ FLOOR DRAIN � GAS RANGE <br /> _ BACKFLOW PREVENTER �_ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN _ i i <br /> _ OTHER _ OTHER <br /> I HEFEBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OR�OINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORIIY 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 TNIS PROPERTY TO PERFORPA THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ��, CONTRA�TORS LAW 18.27 RCW AND 296.200 WAC. <br /> / ` � <br /> I % �, .,` � /I� /�/�- <br /> SignaWre o ner `ntract dAuthonzed Agent ate <br /> � �J� /7.:lgs <br />