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� P�RMIT APPLICATI(�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRF.SS PARCEL TAX I.D.M PERMIT p <br /> � ,y F r�.,�. v,� �� . I Bou;4-��13 <br /> � LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> O\YNER ADDRESS ZIP PHONE <br /> l.J,l�,�» P Fa.�f /— yh�— 7�rr— /12 � <br /> TENANTNAME I CONTACTNAME PHONE <br /> � �7/tit <br /> i <br /> I CONTRACTOR ADDRESS 21P CONTR.UCENSE N <br /> IPHONE d��x`, <br /> f 42s'— 74s'— /12 � <br /> � PROPOSED USE OF BUILDING Building I� Mechanical � Addition HEAT SOURCE <br /> � PERMIT Combinalion H Plumbing WORK Alleralion Electric <br /> ' TYPE Demolilion LJ Sign IYPE New � Gas <br /> Sprinkler RepairiMaint. Olher <br /> I CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �� WORK DESCRIPT�ON � ��u•� ��P�yv/ /w J�ylM'rM <br /> Cy <br /> e F �p� , <br /> PLUMBING MECHANICAL <br /> � N0. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ PJC—A/HANDLING UN�TS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BAS�N) _ HEAT PUMP <br /> SHOWER _ UNITHEATEFS <br /> KITCHEN SINK & DISPOSAL _ CIOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> � LAUNDRY TRAY _ WATEF 4E4TER <br /> CLOTHES WASHER _ METAL IREPLACFJSTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ �AS PIPING <br /> SINK (SERVICE/BAR/t�10P/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CEfiiTIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS CF L1WS AN�ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WH�HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OP A PERMIT�OES NOT PRESUME TO G�VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION QR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE`NORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> GONTRACTOfiS LAW 1827 RCYJ AND 296200 WAC. <br /> Signawre of OwnenCoNractor/Aulhorized Agent Dale � <br /> '�L <br />