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, <br /> pERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8&10- FAX 425-257-8857 <br /> SITE AODRESS N�x7 ?ARCEL TAX I.D.k PERMR M <br /> I y3f Ur �a C -t+� � I '�"!5`f- 2d�- a'Y-d�-�f, <br /> LEGA LOTNO. BLOCK TRACT �-'�S.'� � �i.� " _ <br /> DESC. � �� (a ��,', . - . � � I�-' —y� - . . <br /> OWNER ADDRESS Z1P PHONE . <br /> � . .� . . . ..y, <br /> . , � v,'i � .' I'/� <br /> — • �." /i" ��� , 6 <br /> TENANT NI�ME'� ` / I °CONTACT NAME , P ONE <br /> ��� ' ' C � <br /> - ��, 'r . , <br /> CONTRACTOR� ���%J—�✓t•r.���.��,{�pORESS, �-. - 'l„ , � , ZIP CONTR.UCEN9E 11 'I �C, ,� <br /> � - C � �-_, � _ _ _ . <br /> PHONE � ' . tf � _ �����. . ��r� � . . , . . ' <br /> �% _ . � ' • _ , . . <br /> PROPOSED USE OF BUILOING �8 uilding �I-�1 Mechanical Addition MEAT SOURCE <br /> �, �'"�f.� I TYPE'T B pPd klle�tnon {.1 Signbing TYPE RlePairi/Mainl LJ oectdc I <br /> lJ <br /> CONTRACT PRICE OF WOpK CITY OF EVEHEff LOCAL SAI.cS TAX CODE IS 3705 <br /> WORK DESCRIPTION <br /> � � � ��� ' r � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITtM N0. TYPE OF Fl:RURE OR REM <br /> WATER CLOSET A/C—lVHANDLING UNITS <br /> _� BATHTUB FORCED Alfl SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> � SHOWER UNIT HEATERS <br /> / KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER � RANGE HOOD <br /> IAUNDRY TRAY !' WATER HEATER <br /> CLOTHES WASHER METALFIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DP41N GAS RANGE <br /> BACKFLOW PRE\'ENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) ' EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CEFITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCELTHE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CGNSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.?.7 RCW ANO 296.200 WAC. <br /> / j� . <br /> Signalure oi Owner/ContractodAuthorized Agent •• • Date � <br /> . Z <br />