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i . <br /> PCRMIT APPLICATI�UN � <br /> CITY OF EVERETT PERMIT SERVICES �J' <br /> 3200 CEDAFI STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N • PE MI7 a <br /> y �/ a� o9�i� <br /> LEGAL LOT NO. BLOCK TRA T <br /> DESC. � • /l7-- <br /> OWNER J <br /> A ESS P PHONE <br /> TENANTNAME CONTACTNAME PHONE <br /> 'a^~"e I �a.w�.r ��.,.,.� <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE N <br /> PHONE , / <br /> I'��,L�I=mLLML�� <br /> PROPOSED USE OF BUILDING Building D Mechanical Addition HEAT SOURCE <br /> PERMIT �Comb�nation I, Plumbing WORK R Alleralion R Eleclric <br /> � /� TYPE Demolition U Sign 7YPE R New u Gas <br /> C�T/L�, Sprinkler LJ RepaiUMainl LJ Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA1C CODE IS 3106 <br /> WOHK DESCHIPTION <br /> �1�2 r-�c_£ <br /> PLUMBING MECHANICAL <br /> N0. TYpE OF FIXTURE OR ITEM N0. TYPE OF FlXTURE 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&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 HAV[ READ AND EXAAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND Of71DINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HFr7EIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TC GIVE AUTHORIiY TO VIOIATE OR CANCEL THE PROVISION OF PNY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE�BY THE <br /> OWNER� THIS PROPE Y TO PERFORM THE WORK FOq WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CJ�PI'fRA�RS 1 RCW AND 296.200 WAC. <br /> �/�� 0 2 <br /> Signature of wnedConlractor/Aulhorized Agent Date � <br /> ' z <br />