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KiRMIT APPLICATILN <br />e0_5LM 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. # PERMIT x <br />vrZO-VMD4-fl�ab.� <br />LEGA LOT NO. BL CK TRACT <br />DES C. <br />OWNER ADDRESS ZIP PHONE <br />ley�i/•/�ii� <br />TENANT NAME I CONTACT NAME PHONE <br />CONTRACTOR ADDRESS����O 0 ZIP CONTR. LICENSE M <br />{lherni;C M�d�,tt, v� q p�o�vMci37 3 <br />PHONE �GDGG�/�ia'S vf�0�i1vr/�✓ Ham" i��•�o2/�®/v�Z <br />PROPOSED USE OF BUILDING <br />iS�AE_chanical <br />Addition <br />PERMR <br />Combination <br />�LF-J(( Plumbing <br />Alteration <br />INBuilding <br />TYPE <br />Demolition <br />Sign <br />IWORK <br />TYPE <br />Now <br />IHEATSOURCE <br />�lectric <br />as <br />Sprinkler <br />Repair/Mainz. <br />Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION /I,P9ry�j,,C%i,/,J� YSNµut-.Cg <br />PLUMBING <br />NO. TYPE OF FIXTURE OR REM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />I <br />A/C—A/HANDLING UNITS J re, <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />MZ7AL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORICINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR C. ACEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT TORS LAW 18.27 RCW AND 296.200 WAG. <br />� 414g1 ° 9�vt 3/oa, <br />