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F :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 ADDRESS PARCEL TAX I.D.N PERMIT x �l <br /> :�60� w — 2 3/o - d' <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> i3�.�,i��s �x�A�r.� aEo7 cva�c� qs2a C`�zs� 2s�-i�o3 <br /> TENANT NAME I CONTACT NAME PHONE <br /> C�L <br /> CONTRACTOR ADDRESS LP CONTR.LIC NSEM <br /> EveRaa�.-� 8�trc Ho�T�- /�c 2�z� A►{�-R� Qszo r- �v� c�sazzD7— <br /> PHONE � <br /> L"�7� /4- <br /> PROPOSEO USE OF BUILDING Building echanical AdCition MEAT SOURCE <br /> PERMIT R Combinalion Plumbing IWORK �Alleralion �Electnc <br /> f�GGI� TYPE D Demolition Sign 7vaE New Ges <br /> "�' � U Spnnkler Rapair/Maint. Other <br /> CONTRACT PRICE OF WORK /S11vY'f -� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �.C�� <br /> WORKDESCRIPTION Hv�.G1 �p,s-���_ �� �� Q�'F�CL <br /> �r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTUHE 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 <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE H00� <br /> LAUNDRY TRAY WATER HEATER <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/8AR/MOPlETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> i <br /> I HEREBY CEflITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CQRRECT. AlL <br /> i PROVISIONS OF LAWS ANO ORIGINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OFi <br /> INOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE AUTHOR�TY TO VIOL4TE OR CANGEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOPIZED BY THE <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPIICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACT R W 1827 R U 296.200 WAC. <br /> � a� /o G/a3 <br /> i Signatur.�n or/Aulhonzed Agent ° ate ^ <br /> Y 1 <br /> 2 <br />