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� �," � � —� <br /> I PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICIES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> S r z�0-dd� <br /> SITE ADDRESS PARCEL TAX I.D.# PF�RMI7# <br /> /o / Z/ E�e� �e.er Gva J�l�z'I'l�o <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS IjP PyONE 4.� fj <br /> 1� ) µ",� �z \ y�OC7�l- J <br /> ^�.'ql'/f�H �P�1T'�/'S IG�I � lI I TN�I�'' ✓E �EL��VUL� ��I'- / �JGO <br /> TENANTNAM CONTACTNANE PHONE <br /> /�I,��c, /3ares UPs I EL.eo S/G,eJ o. �pbo) 9s�7- yss s' I <br /> CONTRACTORt �C � ADDRESS ZIP CONTR.LICENSEN � <br /> �ti� � I <br /> 7/(.LGC�7( � <br /> PHONE � <br /> GO�VTAGT� L C) � 7 �- Z�— SSS <br /> PROPOSED USE OF BUILDING I TMPC�T � Spfi kler�n n R Pi9n bing IW�K � Repai IMaint. I HEAT SO�UQR�E <br /> n c� <br /> �g LJ <br /> CONTRACT PRICE OF WORK �8�a �� CIfY OF EVEREff LOCAL SALES TAIC CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHAN{CAL <br /> NO. TYPE OF FI%TURE OR REM NO. I TYPE OF FIXTURE OR REM <br /> WAT[R CLOSET AfC-A/HANDLING UNITS <br /> BATHTUB fORCED AIR SYSTEMS <br /> LAVATORY(WASH AASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER �AETAL FIREPLACEISTOVE <br /> URINAI FIREPLACE INSERT <br /> DRINKING FOUNTAIN ' GAS FIREPLACE <br /> FLOOR DRAIN GAS RP,NGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEIBAFJMOPIETC.) EXNAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT i HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CGri'tECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEI'.1AIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER' <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR W HICH APPLICATIO�IS IMDE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 R^W AND 29G.200 WAC. �j <br /> �uI�c.�! ��-�J--�r-� � �U — / �U� j�- � � 0 0 <br /> SignaNre oF Owried onUactorlAuthonzetl Agent Date �2� <br /> � <br /> ��L <br />