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i <br /> PL,3MIT APPLICATIG�J <br /> (:iTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PEiiMiT a <br /> ;2(02�( �ewc%es7' /�✓� Maa o4-0[ <br /> IEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS ZIP PHONE <br /> .�L M �o«�N 2�O2Y l��ewc�es7� �� 1�'Zo3 �S'zSJ3Y7-/67� <br /> TENANTNAh7E CONTACTNAME / PHONE <br /> � . �oc�.�oi� <y2s' 3�/7 -/G7/ <br /> � CONTRACTOR �mrt �/AM �IQ� � Sov� ADDRESS ZIP CONTR.IICENSEM <br /> tt <br /> PHONE <br /> �� PROPOSED USE OF BUILDING Building ("� Mechanical I Addition HEAT SOURCE <br /> � pEHM1T R Combination �_� Plumbing WORK R Alleralian � Electnc <br /> ' TYPE D Demolilion LJ Sign TYPE D New Gas <br /> U Sprinkler �, RepairRdaim. Olher <br /> iCONTRACT PRICE OF WORK C17Y OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK OESCRIPTION <br /> Re{l�c�c� �0`/ LJ�e� (�'� <br /> /-�dd ex���s,�� i/fw K aUd! c//Z��� �a�„ <br /> PLUMBING MECHANICAL <br /> ' NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET iJC—A/HANDLING UNITS <br /> BATNTUB _ FQFCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL CLOTHES DRYER <br /> DISHVJASHER FANGE HOOD <br />/ _ LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAW . GAS FIREPLACE <br /> fL00R DRAIN _ GAS RANGE <br /> BACKFLOW PFEVENTER _ GAS PIPING <br /> SINK (SERVICE'BAR/MOP/F.TC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEFEBV CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PFOVISIGNS OF WWS AND OPIDINACES GOVEPNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN CR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR I.00AL LAW REGULITING CONSTRUCTION OR THE PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICIi APPLICATION IS MADE ANU I COMPIY WITH THE STATE <br /> CONTF3ACT��S LA�jl�782�0 296.200 WAC. � _/�J_ D-L <br /> l�I (/t t � <br /> SignaWre ol OwneuContractor/Authonzed Agent Date <br />