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PL.�MIT APPLICATIa . <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI'.E ADDRESS PARCEL TAX I.U.M PERMIT M <br /> IGO'7 /lGG/Y�� /<.� MOc{W-(y�0 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> /L/01ilCI LGO/O ��V7 //OGI�G�t���r �V`0/C/ r �F�CI� y.7tr'�S�—�� <br /> TENANT NAME . I CONTACT NAME PF�ONE <br /> CONTRACTOR Ev+���e+� S�oJ. ADDRESS Z1P CONTR.LICENSE M <br /> Sl�,��F M.t./ �/30 l�qcifit A�c �ve�t�" 9&7ci EUEhGSS03?OT' <br /> PHONE <br /> yas�s.�-siiy <br /> PROPOSED USE OF BUILDING Building 6� Mechanical Adtlition HEAT SOURCE <br /> a� PERMIT Combinalion �{.-.(C Plumbing WORK R�( Al�ere�ion R Electric <br /> /��5� TYPE Demolilion U Sign TYPE u New . ,�9 Gas <br /> Sprinkler U Repair/Maint. L� O�her <br /> I CONTRACT PRICE OF WORK �A�� CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> F� <br /> I WORK DESCRIPTION "��� ^_„ �� � /. _ _ p_ � �� �r � <br /> 7�.�. �n.r�A�C.a� CN^0.4a.G/ .�.�.�.a��. <br /> p�- - -- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET A/C—A/HANDLING UNITS <br /> I _ BATHTUB _L FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) HEAT PUMP <br /> I _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> I = DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I _ URINAL FIREPLACE INSERT <br /> � _ DRINKING FOUNTAM GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> ! _ BACKFLOW PREVENTER J GAS PIPItJG <br /> _ SINK(SEr�VICE/BAWMOP/ETC.) EXHAUST FAN <br /> _ OTHEP OTHER <br /> I HEREBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF IAWS AND OAIDINACES GOVERNING THIS T1'PE OF WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br /> OWNER�F THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �. �,�,�� J-/9-oy <br /> Si ture of Ownev�omractodAuthorized-Agent Date <br /> I <br />