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� <br />� <br />RMIT APPLICA' <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />�9S T <br />LEGA LOT NO. BLOCK TRA�T <br />DESC. <br />cS7Z�/E3 Gl.�/���%s <br />TENANTNAME <br />PARCEL TAX I.D. N <br />ICONTACTNAME <br />CONTRACTOR ADORESS <br />2o�8/NsO�� pl1vm6ia� i�•4 , j9��d �t�//� �k�� �`-� <br />PHONE <br />�3(ot�) �fUS - 7�F 6 <br />PROPOSED USE OF BUILDING <br />S� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIP770N <br />Building DMechanical <br />PeRMIT R Combinalion Q Plumbing <br />TYpE �� Demolilion U Sign <br />j� Sprinkler <br />PERMIT A <br />PHONE <br />9d2z3 co�.�ucn �* <br />Addition <br />Alteralion <br />New <br />RepairlMeint. <br />HEATSOURCE <br />�Eiectric <br />Gas <br />OthOr <br />CITY OF EVERETT LOCAL SALES TAX Gooe is 3iva <br />/N� �1�- D �G'E SO�•v�acc�s �•v �d 5 �i2 <br />NO. I n'PE OF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEF <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAFUMOP/ETC.) <br />_ OTHER <br />N0. I TYPE OF flXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />�� OTHE �P�u S <br />I HEREBY CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND COFlRECT. ALL <br />PROVISIONS OF W WS AND ORIDINACES GOVERNING THIS TYPE OF WOiiK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEiiFORM THE WORK FOR WHICH APPUCATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 782 � RC�.A�1D 29620f�/AC. � <br />K O�I-003 � <br />ia <br />