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F, :RMIT APPLICATI�. N <br /> CITY OF EVERETT PERMI i SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-:57-8857 <br /> SITE ADDRESS PARCEL TAX I.D.H P MiT a <br /> /N7,1 1ro�ct�3���� Do ? sy g�do �, 00 �03D lUZ/ <br /> LEGA lOTNO. BLOCK TRACT <br /> DESC. I a I Z S� �f / � �OrU$ a � D l7/�� <br /> OWNER ADDRESS 21P PHONE <br /> � 1.H22Y '�DN,•�so�✓ <br /> TENANTNAh7E I CONTACTNAME PHONE <br /> CONTRACTOp _ /�Nil�/Z GOqJ' S7'/[L(LT�DDRESS �IG_ ��1J. G�A�vI ZIP CONTR.LICENSEA <br /> PHONE � WU-. 90 Z2.3 I.j�l!'E2�2C73M1� <br /> •-'� (, �� �-135- J�� /S r:_`u �/ 7-S 3.S,S �,3�} j <br /> PROPOSED USE OF BUIL�ING Building Mechanical Addition HEAT SOURCE <br /> Ow��� �,i,rJ u ui7 PERMIT � Combinalion Plumbing WORK � Alteralion � Electric <br /> TYPE Demolition Sign TYPE New Gas <br /> Sprinkler aepairiMaint. Other <br /> CONTRACT PRICE OF'NORK y " �OOU O CITY OF EVEFiETT LOCAL SALES TAX CODE IS 31U5 <br /> /\ �U U %� <br /> WORK DESCRIPTION <br /> �cf P��2 ��a�r O�Iwi�/, d— <br /> PLUMBING MECHANICAL <br /> i NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATEFi CLOSET A/C—A/HAND�ING UNITS <br /> BATHTUB �, FORCED AIR SYSTEMS <br /> v LAVATORY (WASH BASIN) HEAT PIIMP <br /> SHOWER _ UNIT HEATERS <br /> � KITCHEN SINK& DISPOSAL 1 CLOTHES DRYER <br /> I � DISHWASHER 1 RANGE HOOD <br /> j � LAUNDAY TRAY z WATEfl HEATER <br /> ' � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> UFINA� FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER I GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CcFITIFY'HAT I HAVE FEAD AND EXAGIINED THIS APPLICATION ANO KNOW THE SAME TO 8E TRUE AND(;ORFECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES�OVERNING THIS IYPE OF WOFK WILL BE COhiPLIED WITH WHETHER SPECIFIED HEFl�IN OR <br /> � NOT. THE GRANTING OF A PERb11LDOES�NOT PRESUM1fE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF <br /> STATE Oi7 LOCAI LAW REGULA tM1G CONSTRUCT�ON OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY��PERFORM THE WORK FOR WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS I:AW�1�8.2�7 R W AN�296.200 WAC. <br /> E�"(-'"r�i l/,�LT�02_ <br /> SignaWre of Ow UC ntr ctor/A�i thorized Agent Dale � <br /> 'v' Z <br />