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PERN��i' APPLIGATION <br /> CITY OF EVERETT' PERiIAIT SEf�VICES <br /> 3200 CEDAR STREET, EVERElT, WA 98201 <br /> 425-257-861 Q- FAX 425-257-8857 <br /> j <br /> SITE ADDRESS �. �yI' ^I PAR(:EL/T�AX I.D.� PE HR M <br /> (I / � �� �'1 ! <br /> �`.7�� �� 1 LY'� '�, �• L. �0 1l C�(���,��1 �O`�.1�_ I /� I <br /> IEGA LOT NO. BLOCK 'fRpC'i <br /> oES�. � �- � N �I CC��CS � <br /> OWNER A�DHESS ZIP PHONE : <br /> ��C��c.�W��� ���vc�SQ�����`�,�a�S� ��:���� ,��� . ��a�a <br /> TENANT NAME CONTACT�lAME���5� � �'a`� PHONE `��L <br /> �1� ����. ������ �3►a-�q'!,��,�;?.����"�q31, � ?��o�,������, j <br /> CONTRACTOR ADORESS � LP CONTR.LICENSEN <br /> (((��� CG�DU'��3'�t�ll � <br /> PHONE ��'(� � <br /> \1\ �kP. IOI aa-I�3 I <br /> PROPOSED USE OF BUILDING Building Mechanical Addilion HEAT SOURCE <br /> S ` l PERMIT Cpmbinalion ' �Plumbing WORK�A�toration (7 Elecfric , <br /> ` `(I� TYPE Uemolilion � Sign TYPE New ,K�Gas <br /> ` 1 ` Sprinkler(a cf heads) Repair/Maint. Ll Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION <br /> �-�� ����j - �le��.�,�,�G� <br /> - � � �\��.� <br /> PLUMBING MECHAIJICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> .� WATER CLOSET(TOILE?) _ A/C—NHANDLING UNITS <br /> BATHTIJB � FORCED AIR SYSTEMS <br /> _ LAVATORY(W�SH BASIN) _ HEAT PUMP <br /> SHOWER UNIT FIEATERS <br /> � KITCHEN SINK 8 DISPOSAI T CLOTFIES DRYER <br /> � DISHWASHER � RANG�HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> 1_ CLOTIIES WASHER METAL FIREPLACE/STGVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ :LOOR DRAIN = GAS R��1GE <br /> _ BACKFLOW PHEVENTER ,� GAS PIPING <br /> _ SINK (SERVIC[l6AR/MOP/ETC.) T� EXHAUST FF�N <br /> _ OThiER ____ OTHFR <br /> — — --— — -- I <br /> - - --- I <br /> - � <br /> I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW 1HE SAh1E TO BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COA1F'LIED WITH WHETHEi7 SPECIFIED fiEf1EIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLI�TE OR CAIJCEL THE PROVISION OF ANY Ol HER I <br /> STATE OR LOCA�LAW REGULATING CONSTRU�TION OR THE PERFORMANCE OF COMSTRUCTION. TNAT I AM AUTHORIZED 81'THE <br /> OWNER O IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR TOR LAW 1827 RCW ND 296.200 WAC. <br /> � ���� ,��1 e a} <br /> Signalure ol Owner/Conlractor/Authorized Agent p 1�- `/ <br /> — � <br />