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� �RMIT APPLICATIC��J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFTT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> � . �-1 -0✓-� <br /> SITE ADDRESS PARCEL TAl(I.D.# PERMIT# � <br /> 1�707 }-l��,ui rl �UL- . 7��'7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AOORESS �-��� �tw� Ax ZIP PHONE <br /> �".:;'� �rit{.�C� �1`11.Y�5iYv�C�Ji Cufr�-���rLl)n . `^1 `6Z01 (�tzs)�97 -N1� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��c_�� C-Ta�s �25-��-saavt��� � <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE X <br /> W1C-2lT �tilC-CtlA�l7fCAL� �'�C • `1��� l.`»R�A�L ��. <br /> PMONE (ZEdw�ouc� � (,(�l�• �$OSZ �+�1CQi���11(e3L�'VI <br /> � � - `. L 4 <br /> PROPOSED USE OF BUILDING Buildlhg eclianlcal ACtliUon HEAT SOURCE <br /> PERMIT B Combination Plumbing WORK R BAteration D jlectric <br /> TYPE Demolition Sign TYPE ���New �✓��Gas <br /> I Z B Sprinkler D RepairlMainl. D Other <br /> Q(`�i Gf/1/ �l7 � <br /> CONTRACT PRICE OF WORK 2 ��C� Od CITY OF EVERETT LOCAL SALES TAIf CODE IS 9105 <br /> ✓ <br /> WORKDESCRIPTION �„-15 'jC� Co/15 j�Gt/Ztif�CL RC-�LnLC•�1/IC�Ui. <br /> 1 za,00v 3r�� 4C/� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HE.4T PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER ,_ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RAtJGE <br /> BACKFLOW PREVENTER _, GAS PIPING <br /> SINK(SERVICEIBARIMOP/ETC.) EXHAUST FAN <br /> � — <br /> OTHER OTHER <br /> I — — <br /> I — <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EX:.MINED i HIS APPLICATION AND KNON'THE SAM11E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINhCES GOVFRNING THIS T1'PE OF WORK IVILL BE COh1PLIED WITH WHETHER SPEGFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERAfIT DOES NOT PRESUM1tE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION GR THE PERFOR6IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OlM1'NER OF THIS PR P RTY TO ERFORAI THE 1YOP,K FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> j CONTRACTOF�S L : .27 RCL3 ND 296.�00�YAC. <br /> � �� � ��� <br /> i it!!i <br /> Signatur of � q ontractodAuthonzetl Agent Date <br /> Rc��/X.c';ir,�c n�yvrf4•be <br /> DEBIT 8 CREDIT CARDS ARL NOT ACCEPTED <br />