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� �" <br /> PERMIT APPLICATION � <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.N pERMrt f <br /> llAl� I�"'Ave � ;� � 103 1�6403-0 <br /> LE LOT NO. � BLOCK T��'�T <br /> DESC. �---��-' <br /> OYYlIER ADDftE38 aP PHONEQ.� <br /> bu.lo�t��r� ����' , �'a.�•rox lo.s, sr�oftrn-ct�t+� WA �PSLg t � S�IS . <br /> TENANTNANE <br /> CONTACT FOR PERNT <br /> ��7 I�oi� ��--���tr�'f�-Ts `�'2s�� 80�� <br /> CONTRACTOR DP CONTR I.ICEN9E t <br /> !'u�f w�C Cp�P• �o. �,c �� ��r-lb'tor� 9S2Z3 �a�erwGlB"i!� <br /> PHOkE p <br /> � v�0 t6`�� - -- <br /> pROPOSED USE OF BUILDING � BUIIdi1g Mechanipl Additlon HEAT SOURCE <br /> r'�,� pERMfi Combination R�-( Plumbing WoftK R�.j /�leretlon R E�eadc <br /> �k�vl 1 I TYpE Demolition IJ Sig� TYPE �..j New �,.{ Gas <br /> Sprinkler �, RepairlMalnt. LJ Otl�er <br /> CONTRACT PPoCE OF WORK /� �! CITY OF EVERETf LOCAL SALES TAX CODE IS 5106 <br /> r <br /> VYORK DESCPoPTION <br /> �'�-�' l�-cPr���T <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIX7URE OR ITEM NO. TYPE OF FIIITURE OR REM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNR HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARlMOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED iH15 APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE CAMPLIED WfTH NMETHER SPECIFlED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CANSTRUGTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUh10RIZED BY THE <br /> OWNE THIS PROPERTY TO PERFORM THE NfORK FOR NMICH APPLICATION IS MADE AND I CAMPLY NATH THE STATE <br /> CO 1827 RCW AND 296200 WAC. n�-- <br /> � '"!�� <br /> SignaW ontractor/Authorized Agent Date � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED L <br />