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P�_:RMIT APPLICATI� -� N � <br /> �ITY 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,i PERMIT x <br /> 5108 Ever �itc� W� (�dO'1—OOa- <br /> LEGA LOTNO. BLOCK TflACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> NL.cJ\� — C,Q,�t,r— S ( 0$ L.vCf'C�r a.Lw �� � O�-�� <br /> TENANT NAME I CONTACT NAME PHONE <br /> CONTRACTOH ADDRESS ZIP CONTR,LICENSE M <br /> 'l�\�'crd (J,�`L� C. \\oa\ \�tiS'`7 Q`• NP.. q ^ <br /> PHONE � ���D �N Q `�,3 y �1��C0 A� '1�15 �L. <br /> PROPOSED USE OF BUILOING � BUilding MeChenlCal � Additlon HEAT SOURCE <br /> I PERMIT Cambinetion Plum6ing WORK Alleralion � Electric <br /> TYPE DAmolition Sign TYpE New Gas <br /> Sprinkler Repair/Maint. Other <br /> CON7RACT PRICE OF WORK ,'1�n� CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> /<rv <br /> WORK DESCRIPTION <br /> �r+�r�\\ ��o•� Tcoa,.. �oo� �0p V�tv� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED Alii SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK& DISPOSAL _ CLOTHES DRYEH <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY • _ WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FfREPLACE INSERT <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 /> _ _ a/ <br /> . /� <br /> I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4WS A�D OR�DINACES GOVEflN�NG THIS TYPE OF WOqK WILL BE COMPLIED WITH WHETHEFI SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEFTY TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFS LAW 18.27 flCW AND 296.200 WAC. <br /> � ��.� ��-Oa <br /> Signature of OwnedContractodAutf(o�Fzed gent Date <br /> v <br /> /i <br />