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�cRMIT APPLICAT�CIN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 U- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.• PERMR w <br /> � �/ ul'i n 29'D SZ O G o Z � �03 c"?a/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS LP PHONE <br /> ��c%/� lmo�nbS / �33 �iec35�ilc/ / � snt�lua•n5� 98x� <br /> TENANTNAME I C�CTNAME PHONE <br /> �f � � <br /> CONTRACTOR ADDRES aP COHTA.LICENSE� <br /> AF��J�di� AbAfe.tip.rl, r�. <br /> PHONE ,3732 `�J�r/�/ /QV� *� A�'�R/�r�O�O GF <br /> �Yrt�ft. [(//4- 9B2-r�/ <br /> PROPOSED USE OF HUILDING Building Mechanical AdCition MEA7 SOURCE <br /> PERMIT � Combination R Plumbing WORK B Alteretion � Electric <br /> TYPE Demolition ❑ Sign IYPE D New Ges <br /> Sprinkler U qepeiuMalnt. Other <br /> CONTRACT PqICE OF WORK S� 9OO, V` �J CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION C�,p7��e7L �Nr�c%�/c�✓ O� f/,� Sf/Zcac�u,p� � SIw.G <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TVPE OF FlXTURE OR ITEM <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUlJDRY TRAY _ WATER HEATER <br /> _ CLOTHES VJASHER METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FI9EPLACE <br /> _ FLOOR DHAIN GAS FANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPINO <br /> _ SINK(SERVICE/DAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED TNIS APPLICATION AND KNqW THE SAME TO BE TRUE AND CORRECT. ALL — I <br /> PROVISIONS OF LAWS ANC ORIDINPCES 30VERNING THIS TYPE OF WORK WILL BE COMPIIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM�T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW NEGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWN[R OF THIS pROPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT CTORS L,4W 78.27 RCbV AND 296200 WAC. <br /> �/7 {� <br /> /'��` $f/��03 <br /> nat e ol OwnedConiracto Au�honzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED j <br />