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�ERMIT APPLICAT�JN <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 aERM17• <br /> 1 �v�cr� .�-� P�oa ► �`�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE �J�� <br /> _� <br /> ` "�tacx ec�e�. ,�nY� � 6`J� �t�'='.o^1�f. �tv r 31�- -01 <br /> TENANT E �� I CONTACTNAME PHONE <br /> CONTHACTOR �l1Ly�, Op�.�,�� ADDRESS ��1��v� �P CONTR.UCENSEM <br /> � � ��L1-NtZ�,�IE <br /> PHONE(��,� y 35 -�13d� I 5 I 31 m��l dey`� ��� oqq kL <br /> PROPOS D USE OF BUILDING Building f l Mechenical I 1dAltion MEAT SOURCE <br /> PERMIT RI--( Combination K Plumbing WORK I-._-(1 nueration R E iec tr�c <br /> / 1�� TYPE u Demolition I J Sign IYPE u New '� �.,.j Gae <br /> 7� �� L� Sprinkler U RepeirRvlaint U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION !—w r _ O(1� � ,r�_ �.00� O,Q� , <br /> Cliv� .�� �� n <br /> � �r� <br /> PLUMBING MECHANICAL <br /> NO. � TVPE OF FIXTUHE OR REM NO. TYPE OF Fl7CTURE OR ITEM <br /> ' WATES CLOSET A/C–A/HANDLING UNITS <br /> I _ BATHTUB _ FORCED AIR SYSTEMS <br /> i _ 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 /> CLOTHES WASHER 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 /> I HEREBY CEFITIFY'HAT I HAVE FEAD ANC E%AMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. PLL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWN OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AN01 COMPLY WITH THE STATE <br /> C TR CTOFS LAW 1 7 RC D 296.200 WAC. <br /> m 1�- 13- 0 � <br /> Signa ure of Owner Coniractor/A orized Agent Dale <br /> ��d����� <br />