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FcRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 1 425-257-8810— FAX 425-257-8857 <br /> 121�t 1-�oy�I" ��r�- ��`9`D3 <br /> SITE ADDRESS PARCEL TAX I.D.# ,a�F MIT z <br /> �`=�i� �� - <br /> LEGAL LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS ZIP PHONE <br /> CY'a� c� �C�rAiS 12`i33 h�w.',..n��„� W� �1-e� �yn5 ��2a`'� <br /> TENANT NAM CONTACT FOR PERMIT PHONE <br /> 'VINI�`��' NZS- 22o—%b(C� INZ91� 347 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEX <br /> PHONE � � <br /> PROPOSED USE OF BUILDING Building fl Mechanical Addition I HEAT SOURCE <br /> � � �� PERMIi R Combinatio� H Plumbing WORK R Alteration I D Electnc <br /> TYPE Demolition IJ Sign NPE New L) Gas <br /> B Sprir.kler Repair/Maint. � U Other <br /> CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK�ESCRIPTION ' <br /> PLUMBING MECHANICAL <br /> NO. NPE UF FIXTURE OR ITEM NO. TYPE OF FIXTURE GR ITEM <br /> 2 )C WA'ER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> �C BATHTUB FORCED AIR SYSTEMS <br /> X LAVATORY(WASH BASIN) _ HEAT PUMP <br /> UNIT HEATERS <br /> _� KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> X DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WAT[R HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PF2EVENTER GAS PIPING <br /> t SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN9 CORRECT. ALL I <br /> I PROVISIONS OF LAWS AN�ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WIiH WHETHER SPECIFIED HEftEIN OR i <br /> I NOT. THE GRANTING OF A PERMIT�OES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER � <br /> STATE OR LOCAL LPW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CUNSTRUCTION. THAT I AM AUTHORIZE�BY THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS PdADE AND I COMPLY WITH TNE STATE II <br /> CONTRACTO S LAW 1827 RCW AN 296.20�WAC. <br /> � i <br /> r��y ° 3 � <br /> SignaWre of OwnerlCo ia lor/ ulhorized Agent Uate I <br /> DEBIT& CR IT CARDS ARE NOT ACCEPTED � <br />