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P�.r�MIT APPLICATICS�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AC DRESS PARCEL TAX I.D.t PERMIT� <br /> �' C� , � � - 1��dc7/�db � - � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER / ADDRE33 LP PHONE <br /> n;m��uiT '� � <br /> 38- 5/?� <br /> TENANTNAME CONTACTNAME � / '� i� pMpNE <br /> _ S�- � �/�sv� �`� 3g8-9S/6 <br /> CONTRACTOR ADDRESS ZIP CONTR.IlCENSE• <br /> PHONE �iY ' / u�J � J <br /> �v f1,0 O O •f7 Gfi � <br /> PROPOSED USE OF BUILDING `�Building I"1 Mecha ica� AddRbn H T SOURCE <br /> PERMIT '�} Combinetion K Plumbing WORK R Aiteretlon � Eteetric <br /> ' TYPE ❑ Demollti0n �J Sign TYPE D New (3ay <br /> —� U S rinklef <br /> d �� a D Repair/Maint. pltw� <br /> CONTRACT PRICE F WORK �a CITY OF EVERETT LOCAL SALE9 TAX CODE IS]705 <br /> WORK DESCRIPTON � � <br /> ,�eii�;or� �X/s /6 �dc� o tl�G �S o /GG.S � � <br /> �,� �,�� �or ,(�i.'s����� Se��i�e.� of'�'y�xr.t�"r��nmuvi�j <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TVPE OF FlXTURE OR ITEM <br /> _ WATER CIOSET _ A/C—MiANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEt�1S <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSA� _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDfiY TRAY _ WATER HEATER <br /> _ CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ UFiihAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/DAR/MOP/ETC.) __ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I MEREBY CEfiITIFY THAT�HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OFiIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPl1ED WITH WHETHER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOUTE OR CANCEL TNE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPE TY TO ERFORM THE WORK FOR WHICH APPLICATiON IS MAOE AND I COMPLY WITH THE STATE <br /> I:ONTRACT RS LAW 18 ' AND 296.200 WAC. <br /> Z �7�-�7� <br /> ' Sign ure ot OwnenContract r/Aulhonzed Agent Date � <br /> ��� <br />