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1 � <br /> r- CRMI1' APPLICATrJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi', WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # PERPdIT 8 <br /> 7_ . F1�e ��,e�e-CC- 2nc�v 3�� -G' �� <br /> LEGi. LOT NC. BLOCK TRACT <br /> DESC. LvtZpLCSS$�.S , �S _� <br /> OWNER A�DRESS ZIP PHONE <br /> f�l�i /1 -�.J ��.SS✓���' Rr�S ��a.� !a� ���.P�f" i.Jq `�SZ�J( 4��'�8 <br /> TENANT NAME CONTACT FOR PE-RMIT PHONE <br /> �`�'�,,ti,eN P. ��es.s.�e r . �l iv�� P l'�-ss�er (4�} Z54-�z�8 <br /> CONTRACTO A�DF7ESS ZIP COkTR.LICENSE N <br /> PHONE n <br /> � C,w 'n P r' <br /> PROPOSED USE OF BUILDING Building f"'1 Mechanical Addilion HEAT SOURCE <br /> PERMIT Combination �_� Plumbinc� WORK Alteretion Electric <br /> TYPE DErt101itiOtl IJ Sign 7Yae New R�( Gas <br /> C��--C� Sprinkler Repair/Maint U Other <br /> CONTRACT PRICE OF WORK �'� , .��_� CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORK�ESCRIPTION <br /> .��;I�Z a. �Ara,qP 7�," kL¢� (/lfif,f�-.ti Od -D�� <br /> ,��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK R DISPOSAL CLOTHES DRYER <br /> I __ DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> � _ CLOTHES WASHER METAL FIHEPLAGE/STOVE <br /> � URINAL FIREPLACE INSEr�I' <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> i _ OTHER _ OTHER <br /> I — — <br /> � <br /> � — — <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SA�dE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEANING THIS TYPE OF WORK WILL BE COMPLIED WITH VJHETHE9 SPECIFIGD HEREIN OR <br /> � NOT. �HE GFANTING OF A PERMIT DOES NOT PRESUME TC GIVE AUTHORIN TO VIOIAI'E OR CANCEL THE PROVISION GF ANY OTHER I <br /> � STATE OR LOCAL L1W REGULATWG CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. TH.4T I AM AUTHORI"LED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY�NITH THE STATE � <br /> . CONTRACTORS LAW 18.27 RC AND 296.200 WAQ � <br /> ���1- � � 1��N � - `� "z � 2 �'.��- <br /> Signawre of OwnedContractor/AWhorized Agent Date �/a <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />