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PERMIT APPLICATIO�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q1 <br /> 425-257-881'J-FAX 425-257-8857 <br /> SITE ADDRESS PARCE TAX I.D.A PERMIT M <br /> �qvl R�c�c� ��� Gb Soi � a -oo5 <br /> LEOA LOTNO. BLOCK TRACT <br /> �ESC. <br /> 1_J��Z � \U I DRE�UC�'�T_ /. �I8' I�CY.7 <br /> �NANT AME CONTACTNAME PMONE <br /> c(�Z I C3�'II �7��t 360 • y;zY- i32s <br /> CONTRACTOR ADDR 43 aP CONTR.UCENSEII <br /> M�,�{- 5�•gH d- �v�l�,'S,:,q �60$ �i,,,y �� S"o u�l� u.t o��T V�1'M u �^-i V..A <br /> PHONE ��U (/��/- I�Z�' �t8zq3 4Uey-vSAa3E�QE <br /> 1 <br /> PROPOSED USE OF 9UILpNG I Building Mechanlcal Addilbn HEAT SOURCF <br /> PERMR B Combinetion B Plumbing WORK �Alteralion Q Electrie <br /> C�C R�"�f 4 I TMPE � Demolitlon �'Sign TYPE New U Gas <br /> Sprinkler � Hapair/Meint. U Other <br /> CONTRACT PRICE OF WORK �j�OUO� CITV OF EVERETT LOCAL SALES TAX COOE IS J706 <br /> WORK DE4CRIPTION r D �` <br /> j,n5���1 [Glv.o��� �l�o��.r�l �Cv"`� �� $r� � �l- Du�'I4� -t <br /> .S LLC �2�7 � <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OH ITEM NO. 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 /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASIIER METAL FIREPIACE/STOVE <br /> URINAL � FIREPLACE INSERT <br /> DRINKING FO:INTAIN GAS FIREPLACE <br /> FLOOR DRAIiJ _ GAS RANGE <br /> BACKFLOW PRE'/ENTER GAS PIPING <br /> SINK(SERVICE/9AR/MOPlETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEFEEY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION A'JD KNOW THE SAME TO BE THUE AND CORRECT. ALL <br /> PROVISIONS OF tAWS AND ORIDINAC[S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIT11 WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO(:IVE AUTHORITY TO VIOLATE OH CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OH TME PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV TtiE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 F W ANO 296200 WAC. <br /> Q,,�,� ��, ��--►y-or <br /> Siqnalure of OwnerlCo aclouAulhonzed Agem ate Q <br />