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P rVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.R PERMIT N <br /> `1�i12 zNe �v� sF Mv10S� bla <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER I ADDRESS IpHONE <br /> �EDt�r1R� P. N�'BU � 9`iIZ ZNo v},,. sr ttie2cl,wn `ib7n8IC�{�S�341�3321 <br /> TENANT NAME I CONTACT NAME PHONE <br /> CONTRACTOR pwN�,� � ADDRESS ICONTR.LICENSEII <br /> PHONE � � <br /> � <br /> PROPOSEC USE OF BUILDING Building � Mechanicai Addition FIEAT SOURCE <br /> PERMIT B Com6inalian Plumbing WORK R Alteration � Electric <br /> TYPE D Demolition Sign TYpE D New Gas <br /> U Sprinkler U RepeidMeint. Other <br /> CONTRACT PRICE OF WORK CtTY OF EVERETT LOCAL SALES TAX CODE tS 7105 <br /> WORK DESCRIPTION <br /> ZNslA6lAT�UN O� T �LLiT S[pve. <br /> Lp UMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FlI(TURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIA SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHFR _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVEN�ER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND URIDINACES GOVERNING TNIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE Pfi0V�510N OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHURIZED BY THE <br /> OWNER OF THIS PRUPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN�I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �,,� �.�;,�u 9����01 <br /> SignaWre ol Owner/C ntractodAuthorized Agent Date <br />