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( <br /> PERMiT APPLICATaON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-887 0- FAX 425-257-8857 <br /> SITE ADDRESS/ PARCEL TAX I.D.R PERMI7� <br /> �jJ��O LC/���-- � 0�' �� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWN • � ADDREBS aP PMONE � <br /> � r�.� ca �1�� � � r cQo�c u��.►re.� _. <br /> TENANT NAME CONTACT NAME , PMONE <br /> I �"e �� C��eink e �laS �aa 3Qo0 <br /> CONTRACTOR 1 1 'l F /7(,�� -g Q[�� ADD�SS , ^1 � I � � 21P COHIA.LICENSE I <br /> 'I U J v lJ 1�� 51 m�ll CVeek <br /> PHONE �[�y� ��� q��'1 <br /> p ol <br /> PROPOSED USE OF BUILDING Building Mechanical I AtlCition I HEAT SOURCE <br /> I PERMIT R Combination Plumbing WORK�Aiteratloo �Eleclric <br /> �� TYPE D Demolition Sign TYPE New Oea <br /> p Sprinkler(M ol heads) RepaldAAalnt. UMr <br /> CONTRACT PRICE OF WORK 5C+��� CITV OF EVERETT LOCAL SALES TAX CODE IS 0105 <br /> WORK DESCRIP710N . <br /> Cl�.hc�e o�.-� Fr�.,,� �I�cfr�c Furr�ce '� Na� �1-� � , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl7(TURE OR ITEM NO. TYPE OF Fl%TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSA� CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY = WATER HEATER <br /> CLOTHESWASHER _ METALFIREPLACE/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 HEREBY CERITIFV THAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TPUE AND CORRECT. ALL <br /> PROVISIONS OF LAIVS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT CTORS LAW 18.27j'- AND 29G200 W C. <br /> C.�)l�. � �i�� L,���� <br /> Sign t r oi Owner/ContractodAuthorized Agent Date <br />