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� ERMIT APPLICA�IJN I <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.� PERMIT M <br /> � 311 Cc�u_ �t Waqe � oO534800 � oz �o Bo�s-oo3 <br /> LE6A LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RE98 ZIP PHONE y�5 z52 .05�1 <br /> [3FN IT'd} SEK{ 2cY 23 I 1 �2�un .S?' �"�'�' � wA q({zo 1 <br /> TENANTNAME I CONTACTNAME PHONE <br /> �3oB F��r�HE �c 1oe � vv3. e� ess <br /> CONTRACTOR ADDRE8S ZIP CONTR.UCENSE 1 <br /> /}Q1� cus��M O,�,oFs PD , �3nx 852 <br /> aRKGuo144i31 <br /> PHONE 3(00 . rjL';. q�7�J"'� � �ON/�eE � v-✓1 9BL'71 <br /> PROPOSED USE OF BUILDINO I Building � Mechenical Addiibn HEAT SOURCE <br /> PEpMIT � Combinelion PIU�IIbI�g WORK � Alleralbn D Electrb <br /> TYPE Demolillon Slgn TYPE New D Oes <br /> Spdnkler RepeldMaint. � OIMr <br /> CONTRACT PHICE OF WORK /�C�f�`� ^ CITY OF EVERETT LOCAL SALES TAX CODE IB J106 <br /> .l J c, <br /> WORK DESCRIPTION O�T FR.M�.. � G/1 n M�� F w/ L o �� <br /> P r Q<< r- t 7- �• i � s� o�Nc- <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF flf(TURE OR REM N0. TVPE OF Fll(TURE OR REM <br /> WATER C�OSET A/C—NFiANDLINa UNITS <br /> BATHTUB _ FORCED AIR SVSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> KITCHEN SINK.3 DISPOSAL _ CLOTHES ORYER <br /> DISHWASHER _ RANCiE HOOD <br /> LAUNDRY TFlAY _ WATER HEATER <br /> CLOTHES WASHFR _ METAIFIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKIN�FUUNTAIN _ QAS FIREPUICE <br /> FLOOR DRAIN _ 4AS RANO� <br /> BACKFLOW PREVENTER _ OAS PIPINO <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIPY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AN:]CORPECT. ALL <br /> PROVISIONS OP LAWS AND ORIDINACES OOVERNINO THIS TYPE OF WORK WILL BE COMPLIED WITH WHETFiER SPECIFIED HEREIN OR <br /> NOT. THE ORANTINO OF A PEFMIT DOES NOT PRESUME TO 61VE AUTHORITY TO VIOLATF.OR CANCEL THE PNOVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REQUU+TINO CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTIIORIZED BV THE <br /> OWNER OF THIS PROPERN TO PEHFORM TME WORK FOF WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONT C� TORS LAW 18.27 RCW AND 288.200 WAC. <br /> l� �_ �- � , .�.�u�,�. 3/�/ (2o�-Z <br /> N-he,��. <br /> ignature o wner oniractor ut o ze gent ate b� <br />