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� CRMIT APPLICAT�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AODRESS PAFCEL TAX I.D.# PERI.t17 N <br /> M�� v ��r��e aao�-oc�� <br /> LEGA LOT NC' BLOCK TRACT <br /> DESC. y. � � <br /> OWNER ADDRESS ZIP PHONE <br /> �/�� �a./.s• 3iv .��� y i- � S4i f��r��- <br /> TENANTNAME I CONTACT'NAME PHONE <br /> -- ��� — 7����1z7 <br /> CONTRACTOR ADORESS 21P CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical Addilion HEAT SOURCE <br /> PERMIT R Combination R Plumbing WORK � Alteration I7 Electric <br /> TYPE D Demolition � Sign TYPE New K Gas <br /> U Sprinkler Repair/MainL LJ Other <br /> CONTRACT PRICE OF WORK !j�;�� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> ��.C//L7(Jr�//LQ rC/7/� <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Flx'fURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <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 DISPOSAL _ CLOTHES DRYER <br /> � _ DISHWASHER _ RANGE HOOD <br /> I = LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK (SERVICE/BAFl/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> _ — <br /> I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COflRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOFiK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL 7HE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED 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 7827 RCW AND 296200 WAC. <br /> I /S,-/.� � Tk lv gS � ao � <br /> SignalurE'o�wner/ConlractodAuthonzed Agent '� Date � <br /> L <br />