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( ERMIT APPLICAT JN <br /> CITY OF EVERETT NERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D N PERMIT w <br /> ;:� i�'�F�Ia� �f. Doa��-�a <br /> LEi3Al LOT N0. BLOCK TRACT <br /> � DESC1 <br /> I OWNEFl ADORESS 2IP PMONE <br /> � � <br /> I ��'�'-2/�N a � y!/�" �✓�r.�i?c �� -a/c/�/CG c�a2 �� c r,��� 9B�o � <br /> i TENA TNAME CONTACT NAME ,� PHONE <br /> + j U� �' )'.� � � <br /> l'��d� � y <br /> ICONfRACTOR �'�J�i�-��J ADDRESS �� LP CONTP. LICENSC•• <br /> � �� �. <br /> � PMONE <br /> � PROVOSE�USE OF BUILDIN6 Building � Mechenical AOAition HEAT SOURCE <br /> PERMIT Com6ination Plumbing WORK R�/ Alterellon Q Electric <br /> I TYPE � Demolition Sign IYPE u New �,j Gae <br /> U Sp�inkler U Repeir/Melnt. LJ Jlhar <br /> CONTRACT PRICE OF W CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> �y`N.,, b„T3,.s'oo —.3, 0 00 <br /> WORK DESCRIPTION - ' �- <br /> .��,�J h��(,. �'�o�.0 AQA, 1 .,-� nurs7�h� �la�2afe� <��� o�� <br /> r�.,�,-,L, f=/��2 � n�4'-Fh. e.t d , <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF fl%TUPE OR REM N0. TYPE OF FlXTURE OR ITEM I <br /> WAiER CLOSET _ A/C-AMANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYEH <br /> DISHWASHER RANGE HOOD <br /> LAUNDRt'TRAY WATER HEATER <br /> CLOTHES WASHEF METALFIREPLACE/STOVE <br /> URINAL FIREPIACE INSERT <br /> DFINKING FOUNTAIN GAS fIFEPLACE <br /> FLOOR DFAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SItJK ISER`/ICE'BAR/MOP/ETC ) _ EXHAUST FAN <br /> OTHER_ _ OTHER <br /> i HEREBV;ERI7IFV'HAT i HPVE PEAO AND EXAMINED THIS APPIICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAP�S AND ORIDMACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED N'ITH WHETHER SPECIfIED HEREIN OR <br /> NOT THE GRnNTiNG OF A PERIAi7�OES N0T PaESUME TO GIVE AUTHURIN TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> SiATE OR LOCAL LAIY REGULATING CONSTRUCTIGN OR THE PERFORMANCE UF CONSTRUCTION. THA71 AM AUTNOPIZED BV THE <br /> OWNEA OF THIS PROPEPT'/TO PERFOPM THE'NOFN FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> GONiRACTORS LAY/ �B 27 RC'P!AND 296200 WAC. <br /> S�gnature o wnenG�ntraclouAulho7zed Agent ate <br />