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�ERMIT APPLICAT�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8d10— FAX 425-257-8857 <br /> (�.ocGti� -(7'f� <br /> SITE AQD�ESS PARC�EL TAX I.D.# PEFiMiT a <br /> � (. �C�. L Jr'�I"� —00 <br /> LE::A LOTNO. BWCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> 1��Y10.s�- hor'L'-� <br /> TEt�ANT NA I CONTACT NAME PHONE <br /> I <br /> CONTRACTOR ^ ADDRESS 'd� 33n ��y<<- ZIP CONTP.LICENSE M <br /> Ko���:� �Ior�b�flu�7.PS: F�re_ Pro{e���on Ad NY ,t <br /> /� Ar1�n�t'or WR• ��00,.3 ���Llv ��a�'o.<.,o, <br /> PHONE \J/„l/1 �7 j ' �"� �c�' <br /> .�. <br /> I pqOPOSED USE OF BUILOING � 6uilding � Mechanical Addition HEAT SOURCE <br /> � � n PERMIT � Combination PlUrtlbi�g WORK � Al�eralion � Electric <br /> � � ,l\(�x I TYPE Demolition Sic�n TYPE New Gas <br /> i � Sprinkler RepairR.7ain1. Olher <br /> I :ONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> i WORK DESCRIPTION <br /> ' �,��i�.-t��, � ��' ne�v �a r� sp�`�„�Izr- s�-tem . 9(� hea�Qs <br /> � <br /> � PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CIOSET A/C—A/HANDLING UNITS <br /> � BATHTUB FOACED AIR SYSTEMS <br /> � _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAI CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> I LAUNDRY TRAY WATER HEATE9 <br /> CLOI�HES WASHER METAL FIREPLACE/STOVE <br /> ' URINAL FIREPLACE INSERT <br /> DPINKING FOUNTAIN . GAS FIFEPLACE <br /> '; _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVEN�iER GAS PIPING <br /> S�NK (SERVICE/BAFi/MOP/[TC.) EXHA�ST FAN <br /> OTHER_ OTHER_ <br /> I HEFEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOIN TH[SAME TO B[TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OP.IDINACES GUVEHNING THIS NPE OF WOHIC WILL BE COAIPLIEO WITH WNETHEq SPECIFIED H�REIN OR <br /> NOT. THE GR.INTING OF A F ERMIT DOES NOT PRESUAIE TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCA�LAW REGULATING CONS i FUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEFi OF T S PRO�N TO PCR�ORA1 THE WORK FOR WHICH APPLICATION IS h1A0c AND I COh1PLY WITH THE STATE <br /> CONTRACT_ LA�V�iB. y RCW AND 296200 PyC. <br /> � � " � �'C' <br /> !,� S .c . ��-._ 0 -o�'' � / <br /> Signatufe� IOwneuContractor/AUlhorizedAyent Da�e IF�. <br /> �v <br />