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P���MIT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810- FAX 425-257-8857 /� <br /> l� � _� <br /> SITE A�URESS PARCEL TAX t.D.M <br /> u4rr s �v� �.�K po�7u9 -���0�10� �9v -o-�/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DEFC. <br /> OWNER ADDRESS ZIP PMON (r <br /> Dc�vN�s -�- 4nco ({q�µAw2 /!g!I Swvb2. I.•Aro��¢. gR.w� e w4 q8za8 <br /> TENANTNAME M� CONTACTNAME PHONE <br /> `'-v� �'d��„� I p�.,�.�.g � P�rw�Ps Go�.•� `G2 <br /> CONTRACTOR����A^) ektiPP,N AOURESS/5016 GR�.�'��� (}l,�p <br /> QQ�3�ONTR.UCEkSE M <br /> PHON�� S�I� '��C.�� �'�G��s � <br /> PROPOSEO USE OF BUILDING p{� Building Mechanical Atlaition MEAT SOURCE <br /> PERMIT �{� Com6inalion R�.�/ Plumbing WORN Alleretlon �Eiectric <br /> �'7 n TYPE u Demolition U Sign TYpE � New I Gas <br /> � I�� L� Sprinkler Rapeir/Mainl. 01her <br /> CONTRACT PRICE OF WORK n� � CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> d— <br /> WORK UESCRIPTION <br /> Q�PR�R �iti�- �9�t.ac.�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fll(TUHE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> � WATER CLOSET _ A/C—A/HANDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> I � SHOWERY(WASH BASIN) _ HEAT PUMP <br /> UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSER7 <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTEN _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) ,L EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATIOY AN�KNOW TME SAME TO BE TRUE/�ND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1YPE OF WO�K WILL BE COMPIIED WITH WHETHEFi SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTF!ORITY TO VIOIATE OR CANCEL THE PFiOVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUC710N OR TFiE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH AFPLICATION IS MADE AND I COMPLY WITH�HE STATE <br /> CONTRACTORS LAW�827 RCW AND 296.200 WAC. r � <br /> y -rrZ -Su�� � 'F`'°-'0� � <br /> g ture of OwnerlContract r/Authanzed Agent Date <br />