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P�,�M',T APPLICATIG.J <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �,� <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M PEfiMiT e <br /> �Z`l 7(UC�CtJ� �1LCr �U�-e^'? ' /�`ZC�2 'DD <br /> LEGA LOTNC BLOC�TR0.CT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> L�ob ���rcc 33ZY %ucntr j� �� Ec��r �di Zs`2 Gq7 3 <br /> TENANTNASti9 CONTACTNAME PHONE <br /> ��zY pc-sz�rc���- �e�s� sos ���s <br /> �ONTRACJ�OR • ADDRESS � ZIP CONTR.LICENSE p <br /> ,- (�,. �--�ucnUrr �o � zs�� Er���(s� 3 � <br /> �.�„ �r�s��-S <br /> PHONE <br /> L(�— �Z ��P�S' <br /> PROPOSED USE OF BUILDING �Building [[[��� Mechanical I I� Addilion I HEAT SOURCE <br /> �Ix,�� �G+���� �5�� PERMIT Combina�ion �Plum6ing WORK f F Al�eration � Eiecvic <br /> 9r 7YPE D�dr••lilion Sign 7YPE �j New Gas <br /> Sprinkler � L] Repair/ldaint. Other <br /> CONTRACT PR�CE OF WOR � �����"j �� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � <br /> �o�C. s �!al7�hT€ c�r ��t�c �lYR�t-'caC�N'1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF fl7(TURE OR ITEM <br /> WATER CLOSET A/C—A/NANDLING UNITS I <br /> I _ BATH�UB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH FIASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSA� CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREF:ACE/STOVE <br /> URINAL FIREPfACE INSERT <br /> DRINKWG FO�JNTAIN . GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> � _ OTHER _ OTHER <br /> � — — —I <br /> I HEREBY CERITIfY THAT I HAVE ReAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF LANS AND OfiIDINACES GCVERNING TIIIS TVPE OF WORK WIIL BE COMPLIED WI;H N�HETHER SPECIFIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHOFITY TO VIQLATE OR:ANCEL THE PROVISION OF AN'!CTHEF <br /> I STATE OH LOCAL L:1W REGUL4TING CONSTRUCTION OR THE PERFOR6IANCE OF CONSTPU:TION. THAT I AM AUTHORIZ°D BV THE <br /> ' OW R OF THIS F GPERTY TO PERFORM THE WORK fOR WHICH APPLICATION IS h1A0E AND I COh7PLY W.fH TNE STATE <br /> � C NT CTORS W 827 flGW AND 296.� WAC. <br /> I <br /> �:���� ���-�.<<� �Z l`l�oZ <br /> ISi Wre ol, w euContractor/Authori ed Agenl Date I <br /> � I <br />