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� <br /> P�RMIT APPLlCATIC�nI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT x <br /> Z 30 R�x cr" L�� PG�{01-G �3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS Z!P PHONE <br /> T l/r /c �' �/�'30.3 G/ 3 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR(]/UM a C2�J,�/ fL'UIr1Q/A�DRESS ��S// ,S/t S.TO Nk ZIP CONTR.LICENSE N <br /> � � aurn8c* o/zK <br /> /��PL(/V6 ,-GN �JA. SgZI.S <br /> PHONE <br /> .360 - y3s' �/.�s�' <br /> PROPOSED USE OF BUILDING I� Building Mechanical Addition HEAT SOURCE <br /> PERMIT K Combination �Plumbing WORK R Alteration D ElecVic <br /> TYPE �� Demofition 'U Sign TYPE D New D Gas <br /> LI Sprinkler U RepaidMaint. U Other <br /> CONTRACT PRICE OP WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTION <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEIA <br /> � WATER CLOSET(TOILET) _ AIC—AIHANDLING 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 FIREPLACEISTOVE <br /> URINAL FIREPI.ACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR ORAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> 1_ OTHER svm P PliN'�/� _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINE�THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CCRRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIE PROPcRN TO PERFORM THE WORK FOR WHICH APPLIC\TION IS MADE AND I COMPLY WITH THE STATE <br /> CGNTR�TGRS LAW 1B RCW AND 296.200 WAC. <br /> /- ZZ - 0� <br /> SignaWre Owner/ actor/Authorized Ageni Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />