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rERMIT �►PPLICATivPd <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8E5� <br /> go3oz-�� <br /> SITE ADDRESS �Lly'�Y7� PARCEL TAX I.D.N pEq�p �2 <br /> 7� � ►���v�F� p�2 wa. l 7.z.9�—1—°29 —0�08 � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ' ADDRESS �— ZIP PNONE ��� <br /> �'o��,� � I��d�<< L'��;,� 7��� �a��-s,F�/�-w �k� ���fi9�� �� z�s� <br /> TENANTNAME CO�jACTNAME PHONE <br /> I Il-DbiN �s�� �y�.�319-9�'jo2 <br /> CONTRACTOR ADDRESS ZIP CONTR.UCENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT �Cembination IR--[ Plumbing WORK � Alteration R Electric <br /> ���� S�,�Q TYPE Demolitioir LJ £'gn TYpE New <br /> �..j Gas <br /> Sprinkler(n ot heads) RepaidMalnt. l.� Other <br /> CONTRACT ppICE OF WOqK /�/ —7 — ��CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> / / <br /> WORK�ESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR REM N0. TYPE OF flXTURE OR REM <br /> _ WATER CLOSET(TOILET) _ 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 /> _ 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/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAh1[TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PAOVISION OF ANY OTHER <br /> STATE OR LOCAL L4W REGULATING CONSTflUCT�ON OR THE PERFORMANCE OF CONSTflUCTION. 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 /> CONTR �OA6 L9�1B.�CW�qND,'��6.200 WAC. , <br /> � �� <br /> Signathte of OwneUContractodAuthonzed Agent Date � <br /> / <br />