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I�cRMIT APPLICATI`�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT x <br /> �So8 7v�: .e� � c�3�3 -�rr <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> S�q,.� /l�qso.� <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ���,�5�ti �fLM 4, �,,,,� ADORESS ZIP CONTR.LICENSE N <br /> �-9a3 o i�-�,� <br /> PHONE iYLt- n-c: 9�Lz3 �OPi�G�f'Z�zc� <br /> l3(ov� �1U 3- �S�loz -9�L'c�..,(n.Tl.� <br /> PROPOSED USE OF BUILDING I BUlldiflg Mechanical Atldi�ion HEAT SOURCE <br /> PEFMIT Combinalion � Plumbing IWORK �eration 17 Electric <br /> Srp TYPE D oliti0n Sign TYPE Naw I � Gas <br /> � �` Sprinkler Repair/Mainl. Other <br /> CONTRACT PRICE OF WORK �3p o-� CITV OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> WORK OESCRIPTION <br /> /iv5 i�?z..— �-S S YSi�7�� /n� �`2'� S f-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> = BATHTUB _ FORCED AIR SYSTEMS 1 <br /> _ LAVATORY(WASH BASIN) HEAT PUMP 1 <br /> SHOWER UNIT HEATERS t ��� <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER �1��j <br /> DISHWASHER RANGE HOOD <br /> = LAUNDRY TRAY WATER HEATER ��� (�� <br /> _ CLOTHES WASHER METAL FIREPIACE/STOVE � <br /> URINAL FIREPLACE INSERT - N � <br /> = DRINKING FOUNTAIN GAS FIREPLACE �il <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARlMOPlETC.) EXHAUST FAN <br /> OTHER OTHER <br /> _ � SY�i,�/Gtt-P .�f�%�rJ� <br /> I HEREBY CERITIFV THAT I HAVE READ AND FJiAMINED THIS APPLICATION AND KNOW TI1E SAIv1E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK'NILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OA <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHCRIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE'.'lORK FOq WHICH APPLICATION IS A1ADE.iND I COMPLY WITH THE STATE <br /> CONTRACTORS WW,t 7 RCW AND 296200 WAC. <br /> Signal�� wne�C�tor�honzed Agent Date <br /> ��2� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />