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�t =RMIT APPLICATI ..N I� <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.D. q PEaM1T s <br /> � —' ��� � �rr.{/����� I/L o0�05 �ooco�, cq � 31.��OQ/ <br /> LEGA LOTNO. � BLOCK TRACT . n ' /� � <br /> DESC. (O �" " I/"I��C'_ NC�I��Y � %, �✓�.�- �U r l � <br /> OWNER A�DRESS 21P PHONE <br /> � � <br /> ��l i''�. r P:<r-� '�i%�?i l�� �l �l`� �� 1N1911k?�.� /�(,f�' l��3� � ��1:: - ���Li � <br /> TEI.ANT NAME CONTACT NAIdE PHONE <br /> CONTRACTOR ADDqESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING �uilding f"") Mechanical � Addltion HEAT SOURCE <br /> PERMIT � ) Gombinalion H Plumbing WORK ,�Atteration � Electric <br /> TYPE g Demolition LJ Sign ITYPE g New Gas <br /> Sprinkler fiepairlh7aint. Other <br /> CONTRACT PRICE OF WORK �/� � — CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> � <br /> WORK DESCRIPTION ' <br /> � ; , ' r"I7';'� �i_�i ;�i <br /> � � I <br /> /G°�' �' ' <br /> 3X S � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATEF CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIFi SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 3 UISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/S'"OVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEiBAR/MOP/ETG) EXHAUST FAN <br /> OTHER OTHER <br /> I HEFEPY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF W�VS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COAIPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERI.71T�OES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLiTE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OF LOCAL LAW REGUtATING CONSTFUCTION OR THE PERFORM17ANCE OF CJNSTFUCTION. THAT I AM AUTHORIZED OY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM TNE WORK FOR WHICH APPLICATION IS h1ADE ANC I COMPLY WITH THE STATE <br /> CONTRACTORS L.i\V t8.27 RG' AND 2962�,W_A__C. <br /> �� �,,�.:�u�� '-��t, ''�1\) � ` � � - �� <br /> Sighature of OwneuContra efiAuthonzed Agent Date � <br /> Z <br />