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P�r�MIT APPLICATIC�J <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 TAX I.D.N PERMiT M <br /> �� � �' �- c:b go 3�S cx�/ �� ,3�ro �oi j <br /> LEGA LOiNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE <br /> �rra �� �, �vc� I�D ( (Z«�,�c., r ��.� 42S ZS8 IYz 1 <br /> IENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> PMONE O�ti�� <br /> PROPOSED USE OF BUILDING I Building Mechanical Addition MEAT SOURCE <br /> �� PERMI7 B Combinelion R Plumbing WORK B A�teral�an Electric <br /> TYPE D Demolition � Sign TVPE R New �R..( Gas <br /> U Sprinkler V R=pair/Maint. U pry�er <br /> CONTRACT PqICE OF WORK CITY OF EVERETT LOCAL$ALES TA%CODE IS JIOS <br /> WOHK DESCRIPTION /D ���� <br /> �p�a c �,�-{ �� � ��� dpc� <br /> I rl' <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF Fll(TURE OR ITEM <br /> _ WATER CLUSET _, q/C—A/HANOLING UNITS <br /> _ BATHTUB _ FORCED Alfi SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> � _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> I _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DFINKING FOUNTAIN _ GAS FIqEPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> I _ BACKFLOW PREVENTER <br /> _ SINK(SERVICE/BAR/MOP/ETC.) — GAS PIPING <br /> � _ OTHER _ EXHAUSTFAN <br /> : — _ OTHER <br /> � _ — <br /> � 1 HEFEBY CEfi171FY THA71 HAVE READ AND EXAMINED THIS A?PLICAT�ON AND KNOW THE SA61E TO BE TRUE AND COFRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TF1E PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW qEGULATING CONSTRUC710N OR THE PERFORMANCE OF CONSTRUCTION. THAT!4M AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITF'THE STATE <br /> . CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ' /D_9 tiZ . <br /> Siynature ot Uwner/Contractor/Aulhonzed Agent �1e � � <br /> i <br /> \L(r� <br /> I <br />