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f ERMIT APPLICA�'C�N ; <br /> CITY OF EVERETT PERMIT SERVICE�, � <br /> 3200 CEDAR STREET, EVERETT, 'J1/A 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> SITE ADDRESS PAHCEL TAX I.D.i PERMfT• <br /> > G (,�Jt�' or �ut DO - 3 D -3�� - o3l- Ov -p <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �� e F�w6J1 /60� w���,o,�t ,4 �, 9fsao � yaf-as� -�sa �G <br /> TENANT NAME I CONTACT NAME PMONE <br /> ::ONTRACTOR �O z J �/1G� ,�� A�DRESS ZIP CONTR.LICENSE M <br /> � �� Lo3YF1Il22Ylqltil <br /> PHONE 3G� -y3S- y9vY av�at-G 1' '/���r ,V•F• i�rl 9g�213 <br /> PROPOSED USE OF BUILDING Building pa Mechenical I Addition I HEAT SOURCE <br /> PERMIT RL1 Cambina',ion H Plumhing WORK Alteration R Electrie <br /> R�c• TYPE �J Demolition LJ Sign IYPE New pgGes <br /> J L� Sprinkler RepaiqMeint. LJ Other <br /> CONTRACT PRICE OF WORK -�3 O G V� U U CITY GF EVERETT LOCAL SALES TA%COGE IS 7105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM NO. TYPE OF Fl7(TURE OR ITEM <br /> WATER CLOSET A!C—A/HANDLING UNITS <br /> BATHT'UB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I _ UFINAI. FIREPLACE INSERT <br /> � DRINKING FOUNTAIN . 6AS FIREPLACE <br /> _ FLOOR ORAIN � GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS AND ORI�INACES GOVERN�NG THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM�T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> 57ATE OR LOCAL LAW REGULATING CONSTRUCTION OR TFIE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITN THE STATE <br /> CGNTRACTORS LAW 18.27 RC1I�AAND 298.200 WAC. <br /> dlz� /Z.�-��r' �� �3-�z <br /> Signature ot Owner/Contractor/Authorized Agenl ate <br />