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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT', WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRES5 n PARCEL TAX I.D.N PERMIT N <br /> Z�Z'�I 1 cot�.r�r�I2� �OlO�'40 <br /> LEGAL L6T NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS PHONE <br /> G-t�� S �aPo,,, � zZzq rzo��<<c�ll� � �so3) ���-y ► <br /> TENANT NAME i CONTACT NAME PHONE <br /> I <br /> CONTRACTOR ADDRESS CONTR.LICENSEA <br /> PHONE s�`'1"- <br /> PROPOSED USE OF BUILDING Building Mechanical nddition HEAT SOURCE <br /> PERMIT R Combinalion �Plumbing WORK R nitere�ion �Eiactric <br /> TYPE D Demolition Sign TYPE � New Gas <br /> D Sprinkler Repair/Meinl. Other <br /> CONTRACT PRICE OF WORK CITV OF EVEflEIT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION 1 1 <br /> 2t� 4�e O�c� C'<Pper l ��c In'P ��KSC 4^� R� I <br /> PP �� �O � � � .,o } � � � �i �,K ) �,�«�� �����-. d <br /> Co cr „ �n<<. � { <br /> s z s , o Co..} o,�•> <br /> PLUMBIN(3 MECHANICAL <br /> NO. TYPE OF FIl(TURE OR REM NO. TYPE OF FlXTURE OR REM <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&OISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGt HOOD <br /> _ LAUNDRYTRAY WAT[R 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/FTC.) _ EXHAUST FAN <br /> _ OTF!ER �ac OTHER <br /> i <br /> �_ o� r S��>e � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORID�NACES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOC LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF f OPER��F' TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONT � . AND 296200 WAC. <br /> — ,_ 9•'�l,-0 <br /> Signalurcf r/Authorized Agent Date <br />