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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 520D CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.q PERMIT a � <br /> �62 7`1� �. �-�'izo-ocn-a(�-olo� �' � � -�c/ <br /> DESG LOTNO. / BLOCK TRACT �_ ^ VA j �r�LlO/V �/�� JZ <br /> 77U Ir ^�" <br /> OWNER ADDRESS ZJP PHONE �jb-.L�B-�j� <br /> �F�►�1 Now�� u-L Po r�x ��N� wt�wca�K ,,� y'�o�� <br /> TENANT NAME I CONTACT NAM_ PHONE <br /> CONT ACTOR ADDRESS ZIP CONTR.LICENSE M <br /> ►4�u� l45 �� <br /> PHONE ��N�L�S� f I I <br /> PROPOSED USE OF BUILDING I � Building Mechanical Addition HEAT SOURCE I <br /> PERMIT Combinalian R Plumbing IWORK � Alteratiun n Electric <br /> TYPE Demolitian p Sign 7vPe Now �p� Ges <br /> Sprinkler(a ol heads) qepair/Maint. LJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3� � <br /> WORK DESCRIPTION � <br /> N�w coNs`rr�vcrr°� o�' IL'23 S. � `ru�v S��Y <br /> .�Nc)L.� F`�ldl��� y ��S r!�-r"]JC� <br /> PLUMBING MECFIANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIF S�STEMS <br /> LAVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWEA UNIT HEATESS <br /> / KITC!1EN SINK& DISPOSAL � CLOTHES DRYER <br /> _L DISHWASl1ER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> Z CLOTHES WASHER METALFIRGPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNiAIN ,�_ GAS FIREPLACE <br /> _ FLOOR DFAIN GAS RANGE <br /> BACKFLOW PREVEN'i ER GAS PIPING <br /> � _ SWK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> i = OTHER _ OTHER_ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT. ALL I <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORF�WILL BE COMPLIED WITH WHEfHER SPECIFI <br /> ED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR CAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE F IS PROPERTY TO PERFORM THE WORK fOR WHICH APPLICATION IS M11ADE AND I COMPLY WITH THE STATE <br /> CONT ACT RS LAW 18 27 W AND 296.200 WAC. <br /> 2 �-� ��2.�1� <br /> SignaWre of OwnedConlractodAulhorized Agent D te �/�i <br /> I �E �aaz'� � <br />