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P�RMIT APPLICATIG�J <br /> CITY OF EVERETT PERMII' SERVICES <br /> 3200 CEDAR STREET, EVERETi', WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDiiESS PARCEL TAX I.D.R PERMIT M <br /> 132`-� 12 \k. ',� '� MO?.�3•OZ� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER �qriS � ��L� I�1U11�V1 I AODRESS ZIP PHONE <br /> � \�25 12Ah1CN(ti ��L �.��-�v � 9�',Z�+ y u2S 355 �,t�71 <br /> TENANTNAME I CONTACTNAME pHONE <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING Building fl Mechanical Addition HEAT SOURCE <br /> PERMIT Combinetion H Plumbing WORK R�( Alleralion R Electric <br /> TYPE DemoliUon LJ Sign 1YPE �,�j New �j Gas <br /> Sprinkler U aepair/Ma�m. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTUHE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> I <br /> WATER CLOSET AiC—A/HANL`UNG 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 _ IAUNDRI 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/MOPlETC.) _ EXHAUST FAN <br /> I OTHER OTHER <br /> , <br /> I HEREBY CEFITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND GORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNI�G THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTqUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPEFTY TO PEflFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.2C0 WAC. <br /> / <br /> ! `_�;r�--� - 3 / r g.�� � <br /> I Signalu� f 4ner/Conlractor/Aulhorized Agent Date <br /> � <br />