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--i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEFiVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> �sITE ADORESS �1 PARCEL TAX I.D.R I PEHMIT N <br /> �1' % �a �i�e;���r� �CT o e N vc�43�G 3�/o 0 2��� <br /> LEDA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS LP PHONE <br /> � �tll..�-•�7� '�. <br /> k �`li/ZI��/ � � .�/V c' � L ���� ��dil/�1-1L7�G d�� /(��C�� Ti�S?S7_�/'I.LL <br /> TENANTNAME { CONTACTNAME � PNONE <br /> � I �- � N/� N/� <br /> CONTRACTOR_ . � ���� / ADDRESS ZIP CONTR.LICENBE� <br /> 'Y ` ' � r,our~� < < � �Xc.°FGE9 out/nl <br /> PNONE <br /> �Jfil7_ _ ?r � � . 9 2Z <br /> PROPOSED USE OF BUILDINO Bu'ding D Mechanical Addllion HEAT SOURCE <br /> S�� PERMIT � binetion U Plu�mbing WORK R Alieretion I7 Electric <br /> � 7YPE ollllon U SI n TYPE � New ❑ Oes <br /> Spri ler fiepair/Melnl. D Olher <br /> CONTHACT PRICE OF WORK � CRY OF EVERETT LOCAL SALES TAK CODE IS 0106 <br /> � <br /> WORK DESCRIPTION �y�a� a �.p1 <br /> ,��Y�.r�-���-- f7°"`'`�-- ��J�/l� o <br /> ' PLUMBING MECHANICAL <br /> NO. I TYPE OF FI%TURE OR ITEM NO. TYPE OF Fl%TURE OR ITEM <br /> � <br /> WATER CLOSET . A/C—NHANDLIN(3 UNITS <br /> _ BATHTUB �, FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) �����" HEAi PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEIJ,;INK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WA5HER METAI FIREPLACE/STOVE <br /> URINAL FIH[PLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> �ACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICElBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERIT�FY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW TI1E SAME TO BE THUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNIN6 THIS TVPE OF WOPK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORI7V 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 /> OWNER OF TIitS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ����7�� <br /> Signelure ol OwnedContraclodAulhorized Agent ale <br />