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P�'�MIT APPLICATIC - 1 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3��G CEDAR STREET, EVERET?', WA 98201 <br /> 425•257-8810- FAX 425-257-8857 <br /> SITE ADDR S PARCEL TAX I.D.# P,E�RMIT e <br /> �. DZ lS Sa� - <br /> Lt A OT NO. BLOCK TRACT <br /> DESC. � <br /> OWNE� �/ r%� ��v W�/l� i��'�! CPl�✓/�i <br /> TENANT NAME CGNTACT NAME PHONE <br /> �2Zf'J'IG�h GH�r'J��l�' I�tM ��V"k •-�zr►'Y��wrA�a� �i. ���'� '� <br /> CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br /> PHONE <br /> I PROPOSEDUSEOFBUILO�NG pERM1T � Spri�nk'leation uPl9mbingal IWORK�RdPao�"31nI I HEA�O�hRCE <br /> TYPE �� Demolilion U Si n T'PE New Gas <br /> U <br /> I ///��� <br /> � CONTRACT PRICE OF WORK��O !'f/Y) 'fb CITV OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> (/W � <br /> WORK DESCRIPTIO ^ n �(/1 �y-A(/`y� <br /> !� ��� �/�1JC��r�4� IY���'/ �i �'/�� G4 '� /, /I� N� <br /> /N���� <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS , <br /> _ LAVATORY(WASH BASIN) HEAT PUMP I <br /> SNOWER UNIT HEATERS , <br /> KITCHEN SINI(8 DISPOSAL CLOTHES DRYEr� I <br /> _ DISHWASHER � RANGE HOOD I <br /> LAUNDRY TRAY WATER HEATER � <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE I <br /> _ URINA� FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERV!CLrBAR/MOP'ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — - I — — <br /> I HEREBY CFRITIFY'HAT I HAVE RfcAD AND EXA�dINED THIS APPLICATION AND KNOW THE SAI.1F.TO BE TRUE ANO CORRECT. ALL <br /> PROVISIONS OF lJ4VS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WIL:6E COMPLIE�WITH WHE?HEFi SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERPAiT DOES NOT PRESUME TO GIVE l.UTHOPITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR I.00:.L LAW REGUTATING CONSTRU�TION OR THE PEPFORMANCE OF COVSTPUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNE F IS PROFEPTY TO PERFORM1I THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONT AC F . �&27 6200 WAC. <br /> � MA�� <br /> Signal�re ol OwneNContractorlAuthonzed Agent Date <br />