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�'ERMIT APPLICAIiC_.�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> ' ,�Y�.��a�' <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT• <br /> �� <br /> LEOA L07N0. ELOCK TRACT <br /> DESC. <br /> OWNEN ADDRESS nP PMONE <br /> TENAHfNAME I CONTACTNAME PNONE <br /> ' 1 �it� W�ld�K� o-----�?aL�7�-o9�ro <br /> ����Y HR�V ANp DIfGT S��lGSADDRESS(elOb 12�AVE. S, aa oNrn.uceNse� <br /> 97�c8 R7►Iea�Xo94QL <br /> PHON�.ZW►�7N.�O�p . <br /> PROPOSED USE OF BUILDIN6 f� Building � Machenical AdOltlon HE11T SOURCE <br /> PERMR rS Combinalbn Plumbing WORK B n��aration Q Qactric <br /> TYPE K Demolilion Sign TYPE ❑ Naw � L] Qas <br /> U Sprinkler U fipsidMeint. U oaur <br /> CONTRACT PRICE OF WOR GTY OF EVERETT LOCAL 8ALE8 TAX CODE IS�106 <br /> �i�.07 <br /> WORK DESCRIPTION <br /> (NSTAIL Ul.-'S� ��R,E S4FPRESS�o�! Sy57E.M <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR fTEM NO. TYPE OF RXTURE OR REM <br /> _ WATEFi CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> ,_ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _. FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ (iAS FIqEPLACE <br /> FLOOR DRAIN _ OAS RANaE <br /> ' BACKFLOW PREVENTER _ GAS PIPING <br /> I — _ EXHAUSTFAN <br /> i _ SINK(SERVICE/BAR/MOP/ETC.) <br /> i <br /> ,_ OTHER_ ,_ OTHER <br /> i — <br /> _ <br /> I HEREBY CERITIFY TNAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO COFRECT. ALL <br /> PROVISIONS OF L4W5 ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WRN WMETHER SPECIFIED IIEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTMER <br /> ; STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPUCATIO4IS MADE AND I COMPIY WITH THE STATE <br /> , CONT CTORS lAW 18. R W PiJD 298.200 WAC. <br /> � 11'/ 'O� /� <br /> SlgnaWre o wned aMroctodAuthodzed Agent a�e �\ <br /> I �/.l, <br />