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R. :RMIT APPLIGATI� N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEFETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.1 PERMrt� <br /> � /.S ' � F9/��v F7d2010-C�L9' <br /> LEGA L01'NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE <br /> , ' , fN � T 7 .��=�'�lG «v� zs-as�y-��� <br /> TENANTNAME I CONTA NAME PMONE <br /> C�7'/�!1[_ <br /> CO ACTOR � ADDRESS jy ZIP CONTR.LICENBE I <br /> eN-Ol//4-�i�'rS�LLL .J-yZ_�/-i3SD�-�S'f" �j�rsD �Qr.',�/ovLs9�yo4 <br /> PMONE��oO'Sln���� c� `�i lOT')v�r��Sli �t <br /> PROPOSELI USE OF BUILD�NG Building I"1 Mechanic8l Addition HEAT SOURCE <br /> PERMfT � Combinetion ��� Plumbing WORK � Altoratbn q Electric <br /> TYPE Demolilion �-� Sign 7YPE New D Gas <br /> Sprinkler Repair/Maint. �� Other <br /> CONTRACT PRICE OF WORK /��7D D - CITY OF EVEHETT LOCAL El1LE3 TAX CODE IS�106 <br /> ( T � <br /> WORKDESCRIPTION ��',/jr pC�C�d�4GG C"Or»�OSi77'O7� /'�00/C ��'J/S�jL�,/'/�V-L <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF Fl7(TURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> WATEF CLOSET A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWEP UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSEFiT <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 NEREBY CERITIFY THAT i HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4WS AND OR�DINACES GOVERNING TNIS TYPE OF WORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRPNTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHEfi <br /> STATE OR LOCAI.LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITM TME STATE <br /> � CONTRACTOfiS LAW 18.2�7`RC�W AND 200 WAC. / <br /> r�� ��2%u2 //�-�/� Cv `��v Z--_ <br /> Signall ure ot Owner/Conlractor/Aulhorized Agent ate <br />