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�`ERMIT APPLICAl _aN <br /> � CITY OF EVERETT PERMIT SERVICES <br /> �"" 3200 C;EDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> 37�9 5�i��h /4 v2 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMiJ <br /> 7Z9 Sl�i(�iGl /4 (/� c7� S7 Ol 9 0 //� 00 �� ` 007 <br /> LEGA LO7N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PMONE <br /> ���� �-����u� 4�z� ����� s�- y�1 -"3y3 <br /> TENANTNA�S'vE CONTACTNAME PHONE <br /> �GIC r �r PR-; �_r_ I To�, h (,c�eiss yz.�= 355 r ��� <br /> CONTHP��P� S/ ��+^ S ADDRESS �, glL n` LP CONTR.UCENSE N <br /> S zoY z3�x *-�j rx %Bty3 � O6� ��- <br /> PHONE <br /> vzj�353—J �6 0 <br /> PROPOSED USE OF BUILDING Building � Mechanical Addition MEAT SOURCE <br /> I PERMI7 R Combination Plumh�ng IWORK R Alleraiion I n Electric <br /> TYPE � Demolition Sign TVPE � New H Gas <br /> Sprinkler RepairMlainl. lJ Other <br /> CONTRACT PRICE OF WORK � �VQ' CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION <br /> � �,�,�..�� oY «-��c� <br /> i <br /> PLUMBING MECHANICAL <br /> , NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> 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 /> CLOTHEF WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE�NSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS P�PING <br /> SINK (SERVICEiBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I H[REBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAh1E TO BE TRUE AND COPRECT. ALL <br /> PROVISIONS OF UWS AND ORIDINACES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED WITH WHE'HEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OP A PERM1IIT DOES NOT PRESUME TO GIVE AUTNORITY TO VIOWTE OR CANCEL THE FROVISION OF ANY OTHER <br /> STATE OR LOC.1L LAW REGUTATING CONSTHUCTION OR THE PERFORMANCE OF CONSTRUCTI��N. THAT I AM AUTHORI2ED BY THE <br /> OWNEF OF THIS PROPERTY'i O PERFORM THE IVORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 FCW AND 296.200 WAC. <br /> �l� C./- �p�� � Z � �2_ <br /> Sig ure of Ow�er/Contractor/Aulhonzed Agert Da e -' � <br /> Pl�-� �� iL <br />