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. <br /> ERMIT APPLICAT�JN <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.x PERMIT r <br /> 2 3,0 2 sr� E vERE1r wk x� 2 i (• v�I <br /> LEGA LOT NO. BU:::K TRACT <br /> DESC. <br /> OWNER ADDRE53 ZIP PHONE y 2`Z � <br /> GEoR6�E f PERRY �Sol RA�NiE,t AVE EvERffr, i✓A qgto� <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ADDHESS LP CONTR.UCENSEA <br /> PHONE O wNER � <br /> PROPOCED USE OF BUILDING Building � Mechanicai Additfon HEAT SOURCE <br /> S f R PERMIT � Combinalion Plumbing WORK R Alteration a7J Etec,ric <br /> 7YPE Demolition Sign TYPE D New � c3as <br /> Sprinkler U RepaiNMeint. Other <br /> CONTRACT PFiICE OF WORK CITY OF EVERETT LOCAL SALES TA%COOE IS 3106 <br /> WORKDESCRIPTION r�4w 641��0I^t � ���i�' � si��� 7� a f�0���� P��tM 1Ci����� j��k/ <br /> wat</ �irr7c�� Wof�r�dly.r, <br /> PLUMBING MECHANICAL <br /> NO. TY�E OF FlXTURE Of�REM NO. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C–A/HANDLING UNITS <br /> I BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> �� KITCHEN SINK 8 DISPOSAL (�- CLOTHES DRYER <br /> �_ D�SHWASHER � RANGE HOOD <br /> LAUNDRY TRAY I WATER HEATER <br /> � � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DFINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) I '� EXHAUST FAN <br /> OTHER _ OTHER <br /> — —I . <br /> I HEREBY CER�TIFV THAT 1 HAVE READ AND EXAMINED THIS APPIICATION AND 1:'.OW THE SAME TO BE TFUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND CRIDINACES GpVERNING THIS 1YPE OF WORK WILL 8E COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRANTfNG OF A PERMIT DOES NOT PPESUME TO GIVE AUTHORITY TO VIOLATE OR CANCFL THE PHOVISION OF ANY OTHER <br /> STATE OR IOCAI lAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPUCATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTFACTOFS LAW 1827 RC ND 296200 WAC. <br /> �ei-,s.. �- �wh„� Il,�l�02 <br /> Signawre of nedContractodAuth zed Agent at�— <br /> . O II -Oo <br />