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PcRMIT 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 4-`7/4Tr wA PARCEL TAX I.D.N PERMIT a <br /> / - S �Pl. S,w. 9kZo D MO>O 3 - 03 Z <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Dov/, Nr Ai ZX -S9 /'l. Jw sill3 <br /> TENANT NAME CONTACT NAME <br /> PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE a <br /> jr 0A. S qr' <br /> PHONE <=v(Rf7T7 "4, `j(f10 b' C - /V5 M l <br /> PROPOSED USE OF BUILDING Building fl MechanicalIH Addnion HEAT SOURCE <br /> PERMIT ll{r�j Combination IIL��SJ( Plumbing WORN Altoro1i0, Irr�I---,,(( Electric <br /> TYPE Demolition Sign TYPE New v Gas <br /> Sprinkler Repair/Mainl. LJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSFT _ A/C -A/HANDLING UNITS <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 L WATER HEATER (474 S) <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/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <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 WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT 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 AIA AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT S LAW 1 �7 RCW NO 9P.200 WAC. <br /> /// <br /> Signature of O%an a or/AUt onzed A� gent — Date <br />