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( <br /> PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �"" 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> //9D/ <br /> SITE A DRESS 5 PARCEL TAX I.O.A pp,�c� CLU Q� P'iM1T� <br /> ���—jC�—S��v�r ��c —� 00 �/ <br /> LEGA LOTN . BLOCK TRAQ7'� � ,/�. /� <br /> DESC. � � .L�f�J -� <br /> OWNER ADDRESS LP PI10NE <br /> M �•.1oo�SC y aq� 1 I�P�S� SF_ 1=��� � 9��G8 33P-7)�f <br /> TENANT NAME I CONTACT NAME PNONE <br /> CONTRACTOR ADDRESS � ZIP CONTR.UCENSE� <br /> PHONE ����J <br /> PROPOSED USE OF BUILDING Buildi�g f"1 Mechanical Additio� HEAT SOURCE <br /> PERMIT R COmbinalion �_� Plumbing WORK R Allerelion �Electric <br /> Li <br /> TYPE D Damolilion LJ Sign TYPE D New Gas <br /> .� U Sprinklor U Repeir/MainL OtY.ar <br /> CONTRACT PRICE OF WORK CITV OF EVERETT LOCAL SALES TAX CODE IS 3/05 <br /> WORK DESCRIP7�ION N C `V NC,N`C /�AZ l��y�% ? . . <br /> 7 / �l(ll� <br /> -��9 , �� �_ <br /> PLUMBING MECHANICAL <br /> NO. ll PE OF FIXTURE OR ITEM NO. TYPE OF flXTURE OR REM . <br /> WATF.R CLOSET � A/C—A/HANDLIN3 UNITS <br /> � BATHTUB � � FORCED AIR SYSTEMS ' <br /> LAVATORY(WASH BASIN) ;J/ _ HEAT PUMP � • <br /> SHOWER UNIT HEATERS <br /> _�_ KITCHEN SINK 8 DISPOSA� _L CLOTHES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> IAUNDRY TRAY _L WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIAEPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPIN6 <br /> _ SINK(SERVICE/BAR/h10P/ETC.) �� EXHAUST FAN /�/ <br /> OTHER_ _ OTHER <br /> I H[REOY CEFITIFY THAT I H�VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRVE AND CORRECT. ALl <br /> PROVISIONS OP I.AWS AND ORIDW�CES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WH�'i HER SPEGFIED HEREIN OR <br /> NOT. THE GRl.NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TH.1T I AM AUTHORI2E�BY THE <br /> OWNEF OF TIi15 PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WI?H THE STATE <br /> CONTRACTORS LAW 18.27 RC�(V AND 296200 WAC. <br /> f� / / // <br /> W !�'f. <br /> Signat re ol Owner/Conlraclo/ ulhor?zed Agent � Date <br /> `�L <br />