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� ,ERMIT APPLICA�'�.�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> PARCEL TAX I.D.M PERMiT n <br /> SITEADCRESS IIO� �OGI'^ ,^ �� Po�� a-��5 <br /> F.�.fL <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER <br /> ADDRESS ZIP PMONE <br /> SNErF���7 , ��CCQ rrv7 2aC�[FrFt.l,F�2 G1✓E ygZvi yzs-� -v�s <br /> TENANTNAME <br /> I CONTACTNAME PHONE <br /> CONTRACTOR Lliv� ADDRESS ZIP CONTR.LICENSE M <br /> p}-Gr�ON 'I�IC� <br /> PHONE <br /> PROPOSED USE OF BUILDING <br /> Building Mechan cal Addition HEAT SOURCE <br /> PERMIT R�.-( Com6ina�ion Plumbing WORK Aheration Gas,ric <br /> TYPE �j Demolilion Sign TMPE Re airlMaint. /� Olher <br /> L� Sprinkler <br /> CONTRACT PRICE OF WORK ti� 7�� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORKOESCRIPTION nGPL/4�C.V WA'�.iIZ SVP��`� J `L� EP�- '� SECuFa'Z ��/N L/NL. <br /> I� <br /> � <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ NC–A/HANGLING UNITS <br /> FORCED AIR SYSTEMS <br /> BATHTUB HEAT PUMP <br /> LAVATORY(WASH BASIN) UNIT HEATERS <br /> _ SHOWER CLOTHES DRYER <br /> KITCHEN SINK& DISPOSAL RANGE HOOD <br /> _ DISHWASHER WATER HEATER <br /> _ LAUNDRY TRAY METAL FIREPLACE/STOVE <br /> CLOTHES WASHER FIREPLACE�NSERT <br /> _ URINAL GAS FIFEPLACE <br /> DRINKING FOUNTAIN GAS RANGE <br /> _ FLOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTER EXHAUST FAN <br /> SINK (SERVICElBAR/MOP/ETC.) pTHER <br /> OTHER — <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINEO THIS APPUCATION ANO KNOW THE SAME TO BE TRUE AND C�RRECT. ALL <br /> PROVISIONS OF t�WS AND ORIDINACES GOVEANING THIS TYPE OF WORK WILL BE COAIPLIED WITH WHETHEii SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLi1TE OR CANCEL THE PRO`JISION OF ANY OTHER I <br /> STATE OR LOCdL LAW REGUTATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> pWI�ER OF THIS PROPERIY TO PERFOFM THE WORIj F R WHICH APPLICATION IS h1ADE AND�COMPLY WITH THE STATE <br /> C NTF�"AC��iS L1W 1827 RCW ANO 6.200 A . <br /> ��� �� �� � ' lZ z��� <br /> , <br /> 9ignature ol ,� wnerl o ractodA�Ihoriz Agent" <br /> • ate <br /> ✓ <br />