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I ��RMIT APPLICATI�N <br /> � CITY �1F EVERETT PERMIT SEkVICES <br /> �T 3200 CEDAR STREET, EVERETT, 1^JA 9f3�Ot <br /> � n � <br /> i d25-257-8810- FAX 425-257-8857 �/ (� ( /'r�/ '�L' 1 <br /> K_�V �pUQ <br /> SITE ADDRESS PAACEL TAX I.D. x PEFI.IIT : `,�!) <br /> ��a�� z-,.b�sr�c, S T Gr�rE� --�,�. <br /> � <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. V <br /> I OWNFR AODRESS ZIP PHONE � I <br />, � �a ti,�-i�� N � �Fu�l�p M c:tv�t� l��-oo sU�.����.,fi11� i�1�z,v s-r��z. <br /> ITENANT NA61E CONTACT NAM1tE PHONE � <br /> .N/,� Se�e w�.� �'-�i r�� C <br />� CONTRACTOR ADORESS ZIP CON i R.LICENSE q <br /> :,�7",/'_IC� 1 t��<C= Pr°T�-C."CZo���tiL, 2�0] ��,,il� <br /> PHONE <br /> � � c�-��_c���. ��,�� �f�om� � liv� ��t-2�- �-RT2,L����'% <br /> —.-,- <br /> PROPOSED USE OF BUILDING (7 Building � MechaniCal n Adtlition HE.4T SOURCE <br /> PERMIT �_� Cam6ination P!umhing WORK '_� Ntera�ion Electric <br /> � TYPE �( Demoliti0n Sign TYPE �q Ne�v Gas <br /> ��(!�ti� �ffJ Spiinkler �, qepairlP+fainl Olher <br /> CONTRACT PRICE Of WORK til,�/.;�� O'� O, 0 V CITY OF EVEREI'T LOCAL SALES TAX CODE IS 3105 <br /> 9 <br /> WOflK DESCRIPTION <br /> �Fj �� J� }�iv'�O �NSTAI \ �� ���- �IoriN !!(cI_S <br /> PLUMBING h1ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEh1 NO. TYPE OF FIXTURE OR ITEhi <br /> WATERCLOSET _ A/C—A/HANDLIPJGUNITS <br /> BATIiTUB _ FOFCED AIR SYSTEMS <br /> LAVATORY (WASH BASM) HEA7 PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYEF, <br /> DISHWASHER RANGE HOOD <br /> LAUTIDRY TRAY WATER HEATER <br /> j _ CLOTHES WASHER METALFIREFLACE/STOVE <br /> ' URINAL FIREPLACE INSERT <br /> , DRINKING FOUNTAIN . _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREDY CEFITIFY THAT!HAVE REA�AND EXA1.11NED THIS APPLICATION AND KNOW THE SA�dE TO BE TRUE AND CORRECT. ALL <br /> PROVISIOi•!S OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILI.BE COMPLIED WITH WHETHER SPECIFIED IIEREIN OR <br /> NOT. 7NE GRANTING OF A PERIdIT�OES NOT PRESUPdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTYtiR <br /> S7ATE OR LOCAL LAbV REGULATING CONSTRUCTION OR THE PERFOR1dANCE OF CONSTFUCTION. THAT I AM17 AUTHORIZED 6Y�fHE <br /> OWNER nF THIS PqOPERTY TO PERFOFM THE WORK FOR`,NHICH APPLICATION IS M1tADE AND I COM1IPLY WIiH THE STATE <br /> TRAC�ORS LAW !827 RCW AND 296200 WAC. <br /> i <br /> SignaWre of Owner/Contractor/nuthorized Agenl Dale <br /> 7�fL. �l <br />