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P�RMIT APPLICATI�N <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.M PERMIT x <br /> 171"l UJct�noce k�M.u�. Moaoa- �� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNEH ADDRESS LP PHONE <br /> ' �ussQU �ocW,�tir�- 1�17 IA,�2(�'v�� I�Utiw�t� �Uena� (A}4 �j$1pl �S'a-8Ky3 <br /> TENANT NAME I CONTACT NAME PHONE <br /> CONTRACTOR ��1 ..��/. y,�� ADDRESS ZIP CONTR.UCENSE M <br /> ri'/Y,LT�ixca <br /> PHONE I�lQ4.ti� IE'�� 4 S..`�'1S Yt<<�rl ` �'I�'S — SOI�DI�'� <br /> PROPOSEDUSEOFBUILDING I TYPEIT H Spnnkliernon �S9^binga1 �PEK �NaPairi/Main�, HEA��CE <br /> LI <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUM8I��G MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TVPE OF fll(TURE OR REM <br /> _ WATER CLOSET _ q!C—A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WP.SH 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 _ METAL FIRE!'LACe/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 CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OPIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NO7. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE 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 /> OWIJER OF,7HIS PROPER'IY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT ORS LAW 7827 RCW AND 296.200 WAC. <br /> �� �-���0'� <br /> Signal ra ol OwnedContractor/Authorized Agent Date <br /> \ <br />