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i -- —; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 58201 ' <br /> 425-257-8810— FAX 425-257-8857 <br /> I <br /> SIT A�RESS \ ���\.qqCEL TA�( I.D.�}I_ \ I PE�QDI "��� i <br /> � --���� � ������ �� <br /> LEGA LOT N0. BLOCK TRACT i <br /> oesc. �� "3 L a�h,�t3E)2!.'� CS T/}Tc3 ; <br /> OWhER PDDRESS � � / ZIP PHONE <br /> G' oc.(=� LYfiL•!'C� InJt...� � � I � Sic.VElz-•�(xL�ypS W/4��� �a7'Aa1WOV✓i �f�. ��2 "tZ, <br /> TENANT NAME CONTACT NAME �C�z,�5 �C.Ar PHONE CGc� <br /> f�jf/� IQ.a�G G�21��3C� .2.�y' 57�5, 33N' S93G, 33v-�-42.� � <br /> CON'fRACTOR AODRESS ZIP CONTR.LICENSE N I <br /> PHONE S��� G o�v�i � u 3 �;.NG � <br /> G-X P. /O�ZZ/0 3 I <br /> PROPOSED USE OF BUILDING fx� Building f� Mechanical (((��� Addition HEAT SOUHCE <br /> n�/ PER6IIT �`� Combinalion R�.Plumbing WORK �Aiteration �Electric <br /> S c � p 1`— U TYPE �1 Demolition �� Siyn TYPE New Gas � <br /> L� Sprinkler(k ot heads) Repair/Mainl. Other <br /> CONTRACT PRICE OF WOFiK CITY OF EVERETT LOCAL SALES TAX COD�IS 3105 <br /> WOR �ESCRIPTION <br /> � c_/k r� �Z 3 (.o <br /> �U �s� ce � \ � \ <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> L` WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> �� LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> 1 KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> T DISHWASIiER I RANGE HOOD <br /> LAUNDRY TRAY I WATER HEATER <br /> 1 CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPL.ACE INSERT I <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN I GAS RANGE n n O` � I <br /> _ BACKFLOW PREVENTER � GAS PIPING � /, `�� <br /> _ SINK�SERVICE/BAR/MOP/ETC.) � EXHAUST FAN �t���� <br /> OTHER _ OTHER I � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH NJHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRP.NTING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE '1 <br /> OWNER OF THIS PROPERN TO PERFORM THE WOflK FOR WHICH APPLICATION IS A1ADE AND I COMPLY WITIi THE STATE I <br /> CO�JTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ' � / %/ /�' I /� L i � 9 <br /> ✓` , ; ��u.:,� r`.t J% �/ �� <br /> Signature of OwnedConVactodAuthonzed Agent { D�te-- 1/ �� <br />