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� PE'. �MIT APPLICATIG. � " -�� �` y i <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 32�9 CEDAR STREET, EVERETT, N1A 98201 i <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PEa i7 u <br /> �3�� ��at���� ���-c ! y�� - ca� <br /> LEGA LOT NO. BLOCK TRACT <br /> DES�. <br /> O ER ADD':ESS ��Z�I PHONE <br /> �<<P�� ��-��t l�x-���cN�s � 3ic -��- -�-,��� atiE ��, ul� )?5-2�-SIJI i <br /> TENANT NAME GONTACT NA6GE PHONE <br /> �N,�. �� WORK-S I J � �� �.ic s `�25-y43 -y��c� � <br /> CONTRACTOfi �� ��� �_��t� �A4DRE�S. �/G ' . 1 ZIP �CONTR.UCENSE N <br /> U �'�� �T� � �OM1lCY�O�W/� �1� 3 <br /> PHONE I�/2S- C/��� �IZ/ F'��«�ZCl�3M <br /> 1 <br /> PHOPOSED USE OP BU�LDING Bwlding I� Mechanical Atltl�t�on HEAT SOURCE <br /> PERMI7 � Combinalion �-� Plumbing WORK R Alteration n Electric <br /> 1--( <br /> TYPE Demolition Ll Sign � IYPE �� New ❑ Gas <br /> Sprinkler ����,(�,t� � Hepair,tda�m. D Other <br /> CONTRACT PRICE OF WORK 2'S�J)3�� �j CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION ����.n� '�- AN .NSUV �/l� N1�-� �Z���- �1'f��IQN <br /> I St`�z�M 1,�S�c AN A�J�OtilvT1�� SPO�I� P�7t4 - � ilU25+/ 9x,uQ1{z,{� <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CIOSET A/C -A/HANDLING UNITS <br /> BATHTUB FORCE�AIH SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _ SHOWER UNIT HEATERS I <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHEfl RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTF'ES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPUICE INSERT <br /> DFINKING FOUNTAIN GAS FIREPLACE � <br /> FLOON DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/8ARl�dOPlETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CEFITIFY THAT I HAVE READ AND FXAIdINED THIS AP?LICATION AND HNOW THE SPME TO 8E TRUE AN�CORRECT. ALL <br /> PRO�ISIGNS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WOFK WILL BE COMPLIED WITH WHETHER SFEGFIED HEREIN OR <br /> NOT. THE GRANTING Of A PERI.�IT DOES NOT PRESUM17E TO�IVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEP. <br /> STATE OR LOCAL LAW FEGULATItJG CONSTRUCTION OR THE PEFFORMANCE OP CONSTRUCTION. THAT I AM AUTHORI2ED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFO�THE WOFH fOF 4NHICH APPLICATION IS MPDE AN�I COMPLY WITH THE STATE <br /> NTRACTORS LA 27 RCW AIJD 29� 00 WAC. I <br /> � <br /> � , � � I <br /> Signature OnmedCon .a ori, Ihonzed gern Date <br /> 1�2 <br />