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a.�RMIT APPLICATIJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERElT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> ��. �Ztti& -oo� <br /> SITE ADORESS PARCEL'fAX I.D.k PERMiT k <br /> I I S`l - � caaas-oa-� <br /> LEGA LOTNO. BLOCK TPACT <br /> DESC. <br /> OWN[R AODRE55 ZIP PMONE <br /> �D�1C'}�� VI r9 i ,v/A �1�Y�PN ��5`/ Q-��,.��!/� 9�'�0� �y�s)a� � d� l � 9 <br /> TENANT NAME I CONTACT NAIfE PHONE <br /> CONTRACTOR A�DRESS 21P CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING I �7y�8uilding MeChaniCal Adtlition HEAT SOURCE <br /> A � PERMIT r-� Com6inalion RI._( Plum6ing WORK R�/ Alteralion [� Electric <br /> �/ ��f TYPE H Demolition u Sign TYPE �J New �,,,) Ges <br /> IJ Sprinkfer L� Repeir/Maint. V Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION ���%�/��_ � �� �,�,✓G����i.�,F/,J /�p-jj� <br /> Pl UMBING MECHANICAL <br /> NO. IyPE OF FIXTURE OR REM N0. TYPE OF flXTUP.E 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 8 DISPOSA� CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> � _ LAUNDRY TRAY WATER HEATER <br /> I _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ UR�NAL FIREPLACE INSERT <br /> , DRINKING FOUNTAIN . GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTEA GAS PIPING <br /> = SINK(SERVICE/BAWMOP/ETC.) �� �- — EXHAUST FAN <br /> OTHER � OTHER <br /> — I � � — - <br /> I <br /> � I HEFEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIO�S OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> � N07. THE GRANTING Of A PERMI7 DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OF LOCAL LAW REGULATING CONSTRUCTION OR TtiE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br /> ' OWNER OF THIS PROPERlY TO PERFORM THE WORK FOR WHICH AFPLICATION IS MADE AND I COMPLY WiTH THE S7ATE <br /> CONTRACTORS LAW 1827 RC AND 200 WAC. <br /> �f1 i � ����`�vl� � � ,1r���1 /�'��ll �f 'S l�� <br /> Si ature of OwnerlContractodAulhonzed AgeD ; Dal � �� <br /> I <br />