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P�tRMIT APPLICATIVN <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �"' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAl(I.D.M • PERMIT• <br /> /33 � � -033 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � <br /> OWNER ADDRESS ZIP PMONE � Zsl_ <br /> l <br /> 1y1�,pl�' WA�CT� /33 2 /Zuckt�+P A,rE �6¢Fn. r,w 9�Zai .2fA 2�L.2 <br /> TENANTNAME CONTACTNAME PHONE � <br /> I <br /> CONTRACTOR ADDRESS aP COHTR.UCENSE• <br /> �Hrj}/ tva J17Quc�7on/ /oq27- 2� Cr 4R. .�(. <br /> PNONE ��n� y8� S C '��fM / <br /> �i,zS -3370 L �� "'A• ! <br /> PROPOSEO USE OF BUILDING R Building �Mechenical Atldition HEAT SOURCE � <br /> I TYPEIT H Spri klleon n Sign bin9 �yPE K RIePe r/Malnt. V Othar �� <br /> LJ U { <br /> COMRACT PRICE OF WORK CRV OF EVERETT LOCAL SALES TAX CODE IS 0105 j <br /> t <br /> WORK DESCRIPTION , <br /> 3 <br /> i <br /> i <br /> PLUMBING MECHANICAL ; <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FlXTURE OR ITEM � <br /> _ WATER CLOSET _ A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP f <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER � <br /> _ DISHWASHER RANGE HOOD � <br /> _ IAUNDRYTRAY � WATER HEATER � <br /> _ CLOTHES WASHER META�FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING � <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> — — 1 <br /> i <br /> I NEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEFiNING THIS TYPE OF VJORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUiHORITV TO VIOLATE OR CANCEL THE PRCVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOf1MANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRCPERTY TO PERFORM THE WORK FOR WHICM APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1821 R AND 296200 WAC. � <br /> _�� I ' �j .�.�i�.f.¢�Q 0,� i <br /> Signawre of t cto/ thorized Agent ete <br /> i <br /> � <br /> � <br />