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� '�d�.s� a�0�� <br /> �'�RMIT APPLICATI�N <br /> CITY 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.O.# PERMIT# <br /> ( 5 �rF Q i- � c DO000 0 o c��-o <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE lf� • aG�J- <br /> AiN�r �I-a�� ����� C-�a-r�wA�i i�n2nc� �✓��rr, r�k y'�ans <br /> ay�y <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � CONTRACTOR ADDRESS ZIP CONTR.LICENSE A <br /> l��t��t /l�(E`Lf�f1-N��AL ZNG•� n.�, S�J� �109 �k'DMLtiY�� Gul9 �fg073 <br /> PHONE � m�rrMzlL3 G� <br /> ��5- $83� 9a�� <br /> PROPOSEDUSEOFBUILDING TMPEIT � C��rlm�ki1eaol�on Pl9nbingal TMP •Repair/Maint, HEATSGedric <br /> ��7vC� �Olher <br /> CONTRACT PRICE OF WORK ��'j3��� �/ CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORKDESCRIPTION �/�7JL( Z 7�N ��e- �(N/l� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A!C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) 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 METAL FIREPLACE/STOVE <br /> URINAL FIRF_PLACE 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 /> I <br /> i <br /> iI HEREBY CERITIFY THAT I HAVE READ AND E.`WMINED THIS APPLICATION A�JD KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE i HER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ISTATE OR LOCAL LAW REGULATWG CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OV.�NER OF 7NIS PROPERTY TO PERFORM THE�VORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> i CONTR G�ORS LAW 78.27 W AND 296.200 WAC. <br /> � �Jz,��- �'�i�nd� �, iy.�S/ <br /> IQ��_SJka�r�c,t � <br /> Signature of OwneNCon actor/Authonzed Agent Date � <br /> IDEBIT& CREDI7' CARDS ARE NOT ACCEPTED I <br />