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RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�EDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TA7C I.D.I{ PERMiT� <br /> 2`-t0 � (3roa�►✓ Qu � 39 iS'f8o 29ao ��7�3 <br /> LEGA LOTNO. BL K TRACT <br /> oesc. 2`t � 30 5`l� f�l�..-{- a� �✓��e� <br /> OWNER ADDRESS ZIP PHONE t <br /> {2u� R� 1n1�5� /�d,/.�x 2d�5� �'rr�..»� F� 9 Ls'.Z 3j�s�' <br /> TENAN AME CONTACTFORPERMIT PHONE <br /> e� �y� �,-,;.��;,t„ /ly,�� l.t/,;-v _ f2�-335�-vfl�' <br /> CONTRA OR ADDRES ZIP CONTR.LICENSE N <br /> PHONE G�''�KF�_ <br /> PROPOSED USC-OF BUILDf�G Building fl Mechanical AdJition I HEAT SOURCE <br /> ���� ,pERMIT Combination F_� Plumbing WORK Alteration Eledric <br /> �s,2�r,�,�' T TYpE �Demolilion IJ Sign TYPE New �Gas <br /> U Sprinkle� Repalr/Maint. Other <br /> CONTRACT PRICE OF WORK /�D�n — CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> 4 <br /> 0 <br /> WORKDESCRIPTIONl� r �rS�� 5������,� ✓� � ��. <br /> �,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> 1 LAVATORY(WASH BASIN) HEAT PUMP <br /> � SHOWER Z UNIT HEATERS <br /> � KITCHEN S�NK 8 DISPOSAL CLOTHES DRYER <br /> DISHV:ASHER ,� RANGE HOOD <br /> LAUNDRY TRAY �_ WATER HEATER <br /> CLOTHES WASHER METAL FIREPL4CE/STOVE <br /> URINAL FIREPLACE ItJSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE.'BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER_ <br /> _ _I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILlBE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NCT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUG710N OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2E�BY THE <br />� OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 8.27 RCW AND 296. 00 WAC. <br /> �31'� �-�/.f�f ����� <br /> Signature of Owner/ nlractor/Authorized Agent Date �I <br /> /]' <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />