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� :RMIT APPLICATI'.,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-B810- FAX 425-257-8857 <br /> SITE ADDRE55 �%t�P/!G� PARCEL TAX I.O.A PEaMiT� <br /> � ,�3-�01..5 r�vc � - 13 0�7-ooz <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PMONE �Z J <br /> �oE/�i we•se yr�3 -C'al��i�'��,�i����� �,52 -Q�z3 <br /> TENANTNAME CONTACTNAME PHONE <br /> �L7HN lil/e�sr I �'���� yz5-�3 z- 9�7_ 3 <br /> CONTRACTOR �n/-Ol//�/7UyjS/ (.;C ADDHESS�S/Z �/35 '�'0/'. S�'• aP CONTR.LICENSE� <br /> /�r/ ,5,�� ��S/, .��g�zs� R�N-o��* 9�S'�9 <br /> PHONE 3�O -J�o6 �- � �.JS <br /> PROPOS'c�USE OF BUILDING I Builtling Mechanical Addition HEAT SOURCE <br /> PERM�T Combinalion R�1 Plumbing WORK Alteration R Electric <br /> 5 �� TYPE � Demolition {� Sign TYPE New �,,,j Ges <br /> Sprinkler Repeir/Meint. U Other <br /> CONTRACT PRICE OF WORK CRY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> WORK DESCRIPT70N T,�r o,r�= , �"�/rj0/- /�f//%J �^'OYl7�f7S/�7�Y! S ���/ rS <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP Fl%TURE OR REM N0. TYPE OF flIfTUHE 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 /> LAUNDRY TRAY • WATER HEATER <br /> CLOTHES WASHER META�FIREPLACE/STOVE <br /> URINAL FItiEPLACE INSERT <br /> DRINKING FOUNTAIN OAS FIREPLACE <br /> FLOOR DRAIN �AS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICElBAR/MOP/ETC.) EXNAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIfY THAT I HAVE REAO AND EXAMINED TNIS APPIICATiON AND KN01N THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF LAWS AND OFiIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW FEGUTATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br /> CON�TRq�O)FiS L4W 1B 7 RCW 296200 WAC. � <br /> ( /[�"y7 �l�"„ �L , � �(JD'Z� n <br /> Signature ol OwnedContractodAuthonzed Agent �� �Dete 'V��O� _ �� <br />