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P�RMIT APPLICATI�N <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-Fb:'7 <br /> ���J7- <br /> SITE ADDRESS / , PARCEL TAX I.D.N / PERMi7►/�' <br /> c<<.,��rt �. PU ?AX A(ct d�l3 .,`�Cizv - a�•�zw csY. �fJ/ <br /> LEGA LOT N0. ^�GJK TRACT . <br /> DESC. 1(�� � ��1��/t, <br /> OWNE � q ADORESS �/ ZIP PHONE <br /> S I J L.. �L�.G J li.x� �� d�H <br /> (�1�. !�. •. � G✓ � -r'z� J�. <br /> TENANTNAME CO ACTNAME/ PHONE <br /> ����n. F(�,��� �N� . �� �'-f .�X�r/ y�>' z� s - o��v <br /> CONTRACTOR A�DRESS ZIP CONTR.UCENSEN <br /> PHONE �� �^ A �Z��L�-r'&�L� <br /> r{ <br /> PHf�POSED USE OF BUILDING I Building D MeChanicel I Addition MEAT SOURCE <br /> rl w � Fi2 PERMIT �Combinalion I ) Plumbing WORK B Alteretion I � Electric <br /> �G TYPE Demolition ��� Sign TYpE ❑ New Gas <br /> Sprinkler � U Repair/MeinL Other <br /> CONTRACT PRICE OF WORK �� �U . CITY OF EVERET LOCAL SALES TAX CODE IS 9105 <br /> WORKD�NIPT;OcN� A l'Z `2✓ !d` SF/L . _ <br /> � J�<u��c- �� zII2� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR 1�EM NO. TYPE OF FlICTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB T FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> �_ SHOWER _ UNITHEATERS <br /> � K�TCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER I RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN I GAS FIREPLACE <br /> = FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) ,� EXHAUST FAN <br /> I _ OTHER _ OTHER <br /> � <br /> � I HEREBY CEFITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfFiER SPECIFIED HEFEIN OR <br /> INOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANV OTHER <br /> , STATE OR LOCAL LAW REGULATING CONS71iUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> : OWNER OF THIS P RN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR �N 1 27 W A .200 WAC. <br /> (r t� OL <br /> Signature of Cont actod uthonzed Agen ate �/� <br />