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P�.0 �MIT APPLICATIO+�; <br /> CITY OF EVERETT �=ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 �� � Q3 � <br /> SITE ADDRESS PARCEL TAX I.D.# PEHMiT <br /> �� C� � cti a � ���D��D07 <br /> IEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE 3c� _ t��j� - <br /> c �S�>� L/�NDr „1�CJ IZa('de/� �/1 /tiTiQ��n�-P�. 1`�t}��73 ��%� <br /> TENANT AME CON ACT NAME PI10NE <br /> [/ / � ��0�/ r✓ I <br /> �G�f�pit.�� �G!'n�il Pif�! � <br /> CONTR CTO ADDRESS ZIP CONTR.LICENSE N <br /> PHONE ���J <br /> U��� �W h/ti/Z <br /> PHOPOSE���F�DING TMPE�T �pPrinB�Uon n �Sign 6in9 al T O EK � AtlPai/Maint. HEAT SG�URCE <br /> � Olher <br /> CONTRACT PRICE OF WORK ��O CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WOflK UESCRIPTION /NS��� ( r'(vcQ nQ/�nL r� R- .3 T�.� ..S /N� , �u� � �� �T �J �(l <br /> r <br /> la,s�q( ( Grt5 ��fJK roR O��v r %NJIII�� :Z ���/�'2� Jn� n��,,,,, �j,/AL� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF Fl%TURE OR ITEM <br /> _ WATER CLOSET _ A/C—A/HANDLING !1NITS <br /> � _ BATHTUB _ PORCED AIR SYSTEMS I <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> i _ SHOWER _ UNIT HEATERS � <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> ' DISHWASHER = RANGE HOOD <br /> i _ LAUNDRYTRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREP.LACE <br /> � FLOOR DFiAIN • GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br />, SINK (SERV�CE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHEP _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS TYPE OF WORN WILL 9E COtAPLIED WITH WIiFTHER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> :TATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BY THE <br /> OWNER OF THIS FFOPERN TO PERFORM THE WORK fOR WHICH APPL�CATION IS MADE AND I COAIPLY WITH THE STATE <br /> CONTRACiORS LAW 16.27 RCW AND 296200 WAC. r� <br /> b-�tn-o,2. <br /> Signa!ure ol Owner/ContractodAuthonzed Agent Date <br /> �L <br />