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'ERMIT APPLICAZ�_ JN <br /> CITY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> l�W,��� <br /> SITE ADDFESS ?ARCEL TAX I.D.# RMIT i! <br /> 1 I 21� ��ni �,r1 U E �c co 5�-4�-c�l or,�2j o4 � a� f l � 00 <br /> LEGA LOTNO.� BLOiK TRACT <br /> DFSC. <br /> OWNER ADDRESS ZIP PHONE <br /> ���y�►°f1-� If�G- 112�5 1�1�i ��I'IU� �� ��208 42S �q�31�<J <br /> TEfVANT NAME CONTACT NAME PHONE <br /> �p�� I PtL-!+N E'�. C.1_R—�I'� �rllt- 5pr�vtE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE p <br /> J.�.ri�.wrc�r� cor��ne.uc�n��a ��o ��x �02�- JG�h�wGt���G <br /> aHor�e 1-`f Nt�l`/�l oo P <br /> 2�h• 42� • C-�4ti�.. �1,(�i1NEx�N 9'So� . <br /> PROPOSED USE OF BUILDING �Building I""1 Mechanical Addition HEAT SOURCE <br /> PERMIT Combination �_� Piumbing WORK Alteration ._ Electric <br /> TYPE Demolilion U Sign TYPE New � Gas <br /> Sprinkler Repair/Maint. �� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> 'rj�M�oLt n o rE o�' W CoD �1C/t-MG 1��I b�t�1C,� . <br /> PLUMBING MECHAN�CAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I, <br /> _ WATER CLOSET A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FOFCED AIR SYSTEMS <br /> I _ LAVATOHY(WASH BASIN) _ HEAT PUMP <br /> I _ SHOWER UNIT HEATERS <br /> i, _ KITCHEN SINK 8 DISPOSAL C�OTHES DRYER <br /> _ DISHW.4SHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL � FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTCR GAS PIPING <br /> SINK (SERVICElBAR/MOP/ETC.) EXHAUST FAPJ <br /> OTHER _ OTHEfl <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETH[R SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCE�THE PFOVISIOIv OF ANY OTHER <br /> STATE OR LGCAL LAW REGULATING CONSTRUCTION OR T4E PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> O NER OF THIS PAOPERTY TO PERFOiiA1 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C fJTRACTORS LAW 16.27 qGW AND 286.200 WAC. <br /> �� - 2�•vn <br /> Signature of OwneUContractor/Authonzed Agent Dale <br />