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•ERM1T APPLICAI�f� <br /> CITY OF EVERETT PERMIT S�RVICE� <br /> 3�Q0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 — FAX 425-257-8857 <br /> SITE ADDRESS `�jD ����/"��I w`� �� pqqCEL TAX I.D.q PE MiT a <br /> ���re-f/P �� �o� 2 —�/�D <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS <br /> LP PHONE <br /> TENANTNAA7E CONTACTNAME pHONE <br /> _ � san,� �lr�a�,� �ao6� -9%3 <br /> CONTflACTOfl�-/�f���„� �'s�_/� S/ AODRESS ZIp CONTR.UCENSE p <br /> ° o r�ox s�.�� �„�w,�/a. p�3� ��rsr�s�9�SK <br /> PHONE G2fJ6,��j,3—���� � � / / <br /> PROPOSED USE OF BUILOING BUilding D Mechanical Addition HEAT SOURCE <br /> PERMI7 B Combination U Plurttbitlg N'ORK � Alleration n Eleclric <br /> TYPE Demolilion U Sign TYPE New Gas <br /> Sprinkler Repair/Maint. B Other <br /> CONTRACT PRICE OF WORK �����— CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � <br /> �q/I.�C� /%ao� /�%r�' S��UI�S/OTf S <br /> I (/ <br /> IPLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEA"PUMP <br /> � _ SHOWER _ UNIT HEATERS <br /> � _ KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD - <br /> � _ LAUNDFY TRAY _ WATER HEATER <br /> ; _ CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> I _ URINAL _ FIREPLACE 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 /> — — �'^��r.� 1��,� jy � SLi/��S.�i1�01/ 51/�7l <br /> U —T � <br /> - I HEREB'f CERIiIFY'HAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISICNS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOPK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERPAIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING COVSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS P.7ADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR$LAW 18.27 RCW AN 296.200 WAC. . <br /> � . �j . " ,�� //—'�— c]�— <br /> Signatu , i wnerl oql�actodAutho ed ent Date I� <br /> / � <br /> r <br />