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�RMIT APPLICATIC��I <br /> CITY OF EVERE'?'f PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> �=os�9oo5dD 7ad <br /> SITE ADDRESS PARCEL TAX I.D.N P MIT r <br /> ba►H �;� 5 - o000 -!s <br /> U.cGA LOT N0. BLOCK TRqCT <br /> s�esc. ,S U47 uF 'x.vCif 2s r =V, 3 <br /> OWNER ADGRESS aP PHONE <br /> NAac.� 8�,s, cn►�sT�,c-�-rc�u <br /> TENANT NAME CONTACT NAME PHONE <br /> � S E� N,�� ti�-a�-ati a9 <br /> CONTRACTOR ADORESS ZIP CONTR.UCENSE M <br /> �1AAc.k (3�s, c��s-�.uc r�uti 39aa s���vE.N E EvereF+ 9esac�s <br /> PHONE <br /> i-125— 3�17—� 36c� ��,k e=o � a �z <br /> PROPOSEO USE OF BUILDING fl BUilding I""1 MOcheniCel fl Atldition ' HEAT SOURCE <br /> PERMIT }S Combination �_� Plumbing WORK �l Aiteralio� � Electric <br /> TYPE �._t Demolition LJ Sign TYPE � New Gas <br /> L) Sprinkler L> Repair/Maint. Olhar <br /> CONTRACT PRICE OF WORK / r� v Uv CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> J <br /> WORK DESCRIPTION <br /> S F R ,�i�!L ��9 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM NO. TYPE OF Fl%TURE OR ITEM <br /> 1 WATER CLOSET A/C—A/HANDLING UNITS <br /> �_ BATHTUB _L FORCED AIR SYSTEMS <br /> '' LAVATORY(WASH BASIN) � _ HEAT PUMP <br /> L� SHOWER UNIT HEATERS <br /> J_ KITCHEN SINK 8 DISPOSAL �_ CLOTHE3 DRYER <br /> i DISHWASHER _L RANGE HOOD <br /> O LAUNDRY TFiAY �_ WATER NEATER <br /> �_ CLOTHESWASHER METALFIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN 1 GAS FIREPLACE <br /> _ F100R DRAIN ! GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINk(SERVICE/BAR/MOP/ETC.) �_ EXHAUST F, N �'� <br /> = OTHER = OTHER_ I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF tANlS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIF''cD HEREIN OR <br /> NO f. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION Of7 THE PERFORMANCE OF CONSTRUCTION. ��HAT I ADA AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PE FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA RS LAW 1827 RCW A .200 WAC. <br /> � L' —Q <br /> gnat oi Owner/ tr or/Authorized ent ate � <br /> � <br />