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P��RMIT APPLICATI�.N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDFESS , PARCEL TAX I.D.N � PERMIT N <br /> 5�Z Fores'1" Drt e� o - D09� QD � �-o�c� <br /> LEf3A LOT NO. BLOCK TRACT 1 �/ � 1 <br /> DESC. Z FOKS-1 PM F� ��^ � EVC1'G <br /> OWNER ADDRESS LP PHQN�O ���� I�D <br /> ��► �l ;relcss Per;r� oTe}��Te.c,ln W��less `� w .a <br /> TENANT ME CONTACTNAME PHONE <br /> _ , R►c.l�ard� C�iJ`cl,o�a 4zsr 4��- G � � (� <br /> CONTRACTOR 'r0 bt /1s�A� ADDRESS �P CONTR.LICENSE 1 <br /> PHONE UJ� �r. <br /> PROPOSED USE OF BUILDIt�(i� Building Mechankal AddNlon HEAT SOURCE <br /> /I I <br /> ��"r� ' ' � ,' TYPE� Deinollionon Si9mbing TMPE Newetbn ��� EOI�ecINc <br /> Sprinkler RepeiNMetnt. <br /> CONTRACT PRICE OF WORK 2�j� ,7Q�. �(' CITY OF EVERETT LOCAL SALES TAX CODE IS 3706 <br /> WORKDESCRIP'T10N RQ �. ,`� `pXIS�AO� Lt/� � 0. • O �1C,W P�1�1�. Ql� • I�AS <br /> o.{- +vp o� e,��s�-�.�' ,e� �AO�OMIi�'f C.��►t� Pu� pot� . ��� ca�+a�d <br /> i� po(e top sl�rovd • ��ns�aU � p � +wo ��tc-Ma��c p�c{u�p�t�,t�1, � <br /> ��b�n�i-s on eotic,��4E s 1 a!o A-I' �iP mF b er . s t c+c c►nw�d u�. <br /> PLUMgING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM NO. I TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEPJ SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ qANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ OAS 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 CEiiITIFY THAT I HAVE FEAD AND EXAMINEO THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEANING THIS TYPE OP WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO QIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAQE AND I COMPLY WITH THE STATE <br /> ONTRA W iB.27 RCW AND 296200 WAC. <br /> �' l��ro�o z- ��z <br /> Sign�of wner/ ontractodAuthorized Agent ete <br /> ���� <br />