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��RMIT APPLICAT�N <br /> 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.M PERMIT» <br /> zo � G� �bo d b oo " 7uo Do� I � � I Yho3oa-o� <br /> LEQA LOTNO. vaF,�.� BLOCK TRACT�^ <br /> DESC. �' 2 C 1 o S��^I� � � <br /> OWNER ADDRE83 ZJP PMONE <br /> E,,..e.�r (� v�t�.�.t, I�� po �3 �y �� .S�c.� w� ���oy (wG� � g•333 I <br /> TENANT NAME I CONTACTONAQ E 1�V �r,-S �p7,. D � � � <br /> V�4,�kCtr�^ S n�� f-��i,l. � �*� r�� u <br /> CONTRAGTOp ADDRES ZIP CONTR.LICENSE• <br /> MU�t,lw(i�'1 ����'�� � �� .S, �ur�S � .�2c.�'(� <br /> PHONE � I G� v1, Lo�s 3�1 �31? vV�' l�fJQ, r10NR'1'( � C �6� � ( <br /> PROPOSEO USE OF BUILDINO r) Building Mechanical n Addltion MEAT 80URCE <br /> , p ,(., PERMIT D Combination � Plumbing WORK [� Alteretion � Electrb <br /> rrQS"w�V(,,,,� TYPE D Demolltion Sign TYPE � New oee <br /> U Spdnkler(w of heeds) Repalr/Maint. Other <br /> CONTRACT PRICE OF WORK �,' 8 G�� �CITY OF EVERETT LOCAL SALES TAX CODE IS 8105 <br /> 0 <br /> WORK DESCRIPTION I h 1'r� A t y�Eft j.. K�'�t,InQ,� IQCy..(�.Q, o( � P Ilb�,� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM NO. TVPE OF flXTURE OR REM <br /> _ WATEA CLOSET(TOILET) A/C-A/HANDLINO 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 /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHEP METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ CiAS FIREPLACE <br /> FLOOR DRA�N _ QAS RANGE <br /> _ BACKFLOW PREVENTER _ (3AS PIPING <br /> SINK(SERVICE/8AR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ _ OTHER <br /> I — — <br /> I HEREBV CERITIFV THAT I HAVE READ AND EXAMINE�THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING fHIS TYPE OF WORN WILL BE COMPLIED WITH WHEfMER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIOY OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY TME <br /> OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND 1 COMPLY WITH THE STATE <br /> CONTRACTOPS LAW 1827 RCW AN0296200 WAC. <br /> ���7� �--, l� zs�� <br /> Signaw�a o Owner/ o tractod uthonzed Agent ate � 1 <br /> � �/� <br />