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�-- <br /> �ERIVIIT APPLICAT�N <br /> I CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI7E ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ior�r2 ���dE SE n3d� ��3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � ADDRESS ZIP PHONE <br /> .fff�✓ -T SCI-f-D� /GY�/z 7�f�dE SE c/g�'OS y�ZS 3531/�oa <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING Buildiny f'� Mecha�iical Addition HEAT SOURCE <br /> PERMIT Combination F_� PlUmb ng WORK � AlteraGcn � Eleciric <br /> TYPE Demolition LJ Sign 7YPE New Gas <br /> Spfinkler Repair/Maint. . Olher <br /> CONTRACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> • CoN��Qr �irR frGE ro �e9n.t�t�/ RODN� ����-"1"'-7�'� ��i�(.y <br /> • �x-t��x. 1 tis . <br /> PLUMBIN MECHANICAL <br /> NO. TYPE OP F�XTURE OR ITEM N0. TYPE OF FIXI'URE OR ITEM <br /> 4VATER CLOSET(TOILET) A/C—A/HANDLING UN!TS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> URINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GA3 PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> BCn.� Oa�— <br /> _ �. a.flt <br /> i — <br /> � i HEREBV CERITIFY THAT I hiAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PftOVISION OF ANY OTHER � <br /> STATE OR LOCAL LAW REGUlATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OVJNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THF.STATE <br /> CONTRACT RS LAW 18.27 �^�W�AND 296�.200 WAC. <br /> � h�• i��it"A.B-,a� S �b �� <br /> ISi Wre of Ow NContractodAut ed Agent Date <br /> � DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />