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� ERMIT APPLICAT�JN <br /> CITY OF EVERETT AERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS P{�RCEL TAX I.D.# P�RMIT x <br /> SL9i/ 6��✓ww��vE oo ��r�0000�So/ 1. o. r'�.I c,2//-oU/ <br /> LEGA LOTNO. BLOCK TRACT <br /> oE n�� � oo�-a.a�/ Sc�'/,�� .S aJ %�SEc36, i..,�24�,2 �E' c.�.Y <br /> � � ADDRESS \ LP HONE � <br /> /"IiCNAEL �44Y.i� �j t��c7jC3,Oa2. GJUvl�tL / ���/ �206��/9 �S�/3 <br /> TENANTNAME I CON7ACTNAME PHONE <br /> CONTRAC70 /� / ADORESS <br /> ��UE' ��/�6EC.oNSl2c�G7��l,vC -���� �� Z�P CONTR.UCENSE M <br /> PHO�+E � �«�.�.z-986.Tr <br /> C�a6� F1�9• �s���� �c.v.4�c, w� �oi9 <br /> PROPOSED USE OF BUILDING Building Mechanical Atldition MEAT SOURCE <br /> PEPMIT � Combination � piumbing WORK � Alteration I7 Electric <br /> TYPE Demolilion Sign TYpE New p� Gas <br /> Sprinkler Repair/fdainL LJ piher <br /> CONTRACT PRICE OF WOqK p <br /> p.�.� O[O CITY OF EVERE7T LOCAI SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> /�� Wocst� .�'2Atiie�� `.JiNF,ccf' �.HiLcr /�c'S:at�.�/cE' <br /> � 37 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM NO. TYpE OF FIXTUitE OR lTEM <br /> �_ WATER CLOSET A/C-A/HANDUNG UNITS <br /> I 3 BATHTUB 7 FORCED AIR SYSTEMS <br /> 3 LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> i / K I T C H E N S I N K S DISPOSAL / CLOTHES DRYER <br /> I / DISHWASHER � RANGE HOOD <br /> LAUNDRY TFAY / WATER HEATER <br /> � CLOTHES WASHER _ METALFIREPLACFJSTOVE <br /> i _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUN?AIN L_ GAS FIREPLAf,E <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER 4� GAS PIFING <br /> _ SINK(SERVICFJBAR/MOP/ETC.) �_ EXHAUST FAN <br /> _ OTHER <br /> _ OTHER <br /> I HEREBY CERITIFY 7HAT I HAVE READ A�ID EXAM17INED THIS APPLICATION AND KPJOW iHE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF UWS AND OFIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEfi SPECIFIED HEREIN OF <br /> NOT. THE GR NTIt7G OF A PcRh11T DOES 110T PqESUA1E TO uIVE AUTHORITY TO`JIOL\TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LO AL LAW qEGUL1TING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUlHORIZED BY THE <br /> OWNER OF T PROPERTV TO PERFORti HE'NORK FOR WHICH APPLICATION IS M11ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS .W 1g,t7 RCW AN029:2001yqC. <br /> i �, <br /> 4. c�-CL /v -�Ft-OZ <br /> Signalure OwnevConhactodAulhonzed A�ent Dato <br /> � � �Z <br /> � <br />