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PERMIT APPLI(��►�TIG+N <br /> CITY 7F EVERETT PERM;T SERVICES <br /> 3200 CEDAR STREET, EVEREiT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> S�TE ADDRESS PApCEL TAX I.D.8 P AtIT a <br /> - _��o3�q-o� � <br /> LECA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS <br /> ZIP PHONE <br /> TENANT NAME CONTA T NAME <br /> � �,c�,�l�k��--�°C��2_ <br /> C�NTRACTOR � ADDRESS � <br /> _ ZIP CONTR.LICENSE M <br /> PNONE � �� ` � � - � . <br /> i <br /> PROPOSEDUSEOFBUILDING � Bi�ilding MecheniCel ,L,L,Lccc{{{/// Adtlition HEATSOURCE <br /> � I PERMIT R Con.binetion � Plumbing WORK �qi�eretion R Electric <br /> TYPE D Dem��ition Sign I7YPE ` �New u Gas � <br /> D Spnnkler(s o1 heaas) Repeir/Maint. I LJ Other � <br /> CONTRACT PRICE OF WORK CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> WORK DESCRIPTION I <br /> i <br /> �G?'/J/br� I <br /> / <br /> PLUMBING MECHANICAL <br /> NO, TYP[OF FIXTURE OR ITEM NO. TYPE OF FI7(TURE OR REM <br /> _ WATER CLOSET(TOI�ET) _ q/C–A/HANDLING UNITS � <br /> _ BATHTUB _ FORCED AIR SYSTEMS i <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRYTRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ META�FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ !'LOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING I <br /> __ SINK(SERVICE/BAW'MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER__ <br /> _ OTHER <br /> — I <br /> — � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINE�TNIS APPLICATION AND KNOW THE SAME TO BC TRUE AND CORRECT. :.L: <br /> PROVISIONS OF LA AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFI�D NEREIN OR <br /> NOT. THE GRANT OF A PE IT DO NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCE!.THE PROVISION OF ANY OTHER <br /> STATE O L A REG TING STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TH:.T I AM AUTHORIZED BY THE <br /> OWNE F � I O E T PE RM THE WORK FOR WHICH APPL�CATION MADE AND I COidPLY\`tlTH THE STATE <br /> CONT, R A 18 7 296200 V✓AC. <br /> ,�ature of OwnerlContracto/ thonzed Agenl p�e O� <br /> � <br />