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P�RMIT APPLICATIt��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 � rn D���� <br /> C--ve^>'�'� PARCEL TAX I.D.H PERMIT u <br /> S7Jy lQ' `� O^• W , WA �.� ,� <br /> LEGA LOT NO. BLOCK TRAC7 JJ�z <br /> DESC. <br /> OWNER ADDRESS - <br /> ZIP PHONE <br /> Se�(-� Yu-e i�„� � <br /> TENANTNAME I CONTACTNAME PHONE <br /> � W n'� ,� <br /> CONTRACTOR A�DRESS ZIP CONTR.LICENSE p <br /> PHONE <br /> PROPOSED USE OF BUILDING Building Mechanical I� Addition HEAT SOURCE <br /> PERMIT Combination IR.-( Plumbing WORK ��� qlteretion � Electric <br /> TYPE Defiolition LJ Sign 7ypE �--� <br /> I..1 New Gas <br /> Sprinkler U Repai//Mainl. Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION �- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FIXTURE OR REM <br /> _ WATER CLOSET <br /> _ BATHTUB — aC-aHANDLING UNITS <br /> I _ LAVATORY(WASH BASIN) — FORCED AIR SYSTEMS <br /> _ SHOWER _ HEAT PUMP <br /> _ KITCHEN SINK 8 DISPOSAL — UNIT HEATERS <br /> DISHWASHE9 _ CLOTHES DRYER <br /> i _ LAUNDRY TRAY — RANGE HOOD <br /> i _ CLOTHES WASHER — �NATEfl HEATER <br /> _ METAL FIREPLACE/STOVE <br /> � _ URINAL _ FIREPIACE INSERT <br /> , _ DFiINKING FOUtJTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> __ SINK(SERVICE/BAFUMOP/ETCJ EXHAUST F�,N <br /> _ OTHER � OTHER (e�7cq��.,n 2 <br /> '— _ _ }Eq � .i�n{-' <br /> I HEREBY CEFITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECI'. ALL <br /> PROVISIONS OF LqWS AND ORIDINACES GOVEFNING THIS TYPE UF WOFiC WIL�BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE PUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF <br /> STATE OR LOCAL LAW pEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOF WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRAC70RS LAW 10.27 RCW AND 296200 WAC. <br /> �i .� s/z�/o Z <br /> 8ignat O nedComractodAuthonzed Agenl Dale <br /> �MO o'�bj - O �-? <br />