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�RMIT APPLICAT�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, WA 98201 <br /> 425-257•8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N I PEJ RM�M <br /> a � �, e � Av� �l - oySr <br /> LE6A L07N0. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PMONE <br /> Th��mas � �c��o n �.yl� f�Ake r /��e `i�-a� �1���-33`i-6►i� <br /> TENANTNAME I CONTACTNAME PHONE <br /> COHTRAG70R 1 /� ADDRES��8 ZIP CONT/R�.�UCCENSE� <br /> �O.Ve.`J ��'�j\�n11��11k/� 1 � � 1\' 1JrOU�W�p rxn ^ C �.w.�l..-k <br /> PMONE Evfrf�. �� l► � Vd�+/ I DAVE��T.o5oA�5 <br /> PROPOSED USE OF BUILDINO pERMIT 1� Sp�Inklealian R Plu bing I WORK 1-( RdepelrlMelnt. HEAT SE�RC�E <br /> TYPE K Demolllion p Slgn TYPE i� New � Other <br /> CONTRACT PRICE OF WORK , I O ��j, CfTY OF EVERETT LOCAL SALEB TA%COOE IB J10S <br /> V <br /> WORK DESCRIPTION <br /> �nstall; �� �` `�as 1 '�ne (tJc�}u,cn.�) -FroM m�e-F2r to gc�.�, Ati1�'2r �'1-�A ( <br /> �,nd �rns 'i ��,ert, wh''cYi tL�e� o� re AI--�� � ���AII ; ^� <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR REM N0. TYPE OF flIfTURE OR fTEM <br /> WATER CLOSET A/C-A/HANDLINO UNITS <br /> BATHTUB _ FORCED AIH SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK.& DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANOE HOOD <br /> LAUNDRY TRAY Z WATER HEATEH <br /> _ CLOTHES WASHER _ METALFIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKINO FOUNTAIN � QAS FIREPUICE <br /> FLOOR DiiAIN OAS HANdE <br /> BACKFLOW PREVENTEfi (3A5 PIPIN/3 <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEFEBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINnCES GOVERNINa THIS TVPE OF WORK WIIL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEH <br /> STATE OR LOCAL LAW REGUTATIN6 CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZEO BY THE <br /> OWNER OF THIS PROPERTV TO PERFOHM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT ,FAW 18.27 RC�7�88.200 WAC. / <br /> � (,/`�( C�✓�h�CSo�9�-Qij/L � C�'ZJ <br /> S gnature o wner/ oNractor ul o ze gent ete <br />