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P�RMIT APPLICATI(,�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PE�MIT a <br /> 3C310 .25 51-�e�f O Z G� �J/ � F;l7dG4-D�`� <br /> LEGA l0T M1'O. BLOCK TRACT � <br /> DESC. <br /> OWNER pDDRESS J ZIF '�HONE <br /> £V:�?� <br /> �c��..ti� � � r0.0 �o �0 25 sf 49 1.. r^srz� , �F�� 303.3 I� <br /> TENANTNAME I CONTACTNAME PHONE <br /> N/ � <br /> CONTRACTOq ADDRESS 21P CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING f� Building✓ I� Mechanical ��ddition HEAT SOURCE <br /> ��� � �yq,�? PERMIT K Combination K Plumbing WORK 4iteretion 1 Electric <br /> TYPE �1 Demolilion �) Sign TYPE �ew a�l R�-( Gas <br /> L� Sprinkler Repair/Maint. V Olher <br /> . � �tr <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOC 4L SALES TAX CO�E IS 3105 <br /> i WORKQESCRIPTION �J`� '� 4 �� , / b y �5 � W � �h 31R� �^s <br /> J <br /> i <br /> IPLUMBING MECFiANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ' _ WATER CLOSET _ A/C-A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HtAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOU <br /> _ LAUNDRYTRAY WATER HEATER <br /> _ CLOTHES WASHER ` tiiEiAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUN7AIN _ GP,S FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOF/ETC.) _ EXHAUST FAN <br /> _ OTHER_ _ OTHER <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMIDIED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF tAWS AND ORIDINACES GOVERNING THIS 7YPE OF WOqK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN CR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIV TO VIOLATE OR CANCEL THE PROVI.SION OF ANY OTHEfl <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TF!AT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO pERFORM THE WORK FOF N.'HICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO�CTORS LAW 18.27 RCW AND 29620G WAC. <br /> �� ��'-1 �- �C�• OuZ <br /> Signature of OwnedCon todAuthorized Agent Date / <br />