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Pr,:RMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AD RE S PAACEL TAX I.D.• P RMIT• <br /> Z ft�►! Au�.. �vr�c r�A <br /> LEGA LOT NO. BLOCK TRACT <br /> oesc. 86 6 7 VoUlME3 s2 qrk�lffff" <br /> OWNER ADDRESS ZIP PXONE <br /> �Vt+�71�S16�iPs Z�33 c.d-�r� Ave. evr,,�rWA ��to� EfarJ t52.�sl�� <br /> TENANTNAME CONTACTNAME PMONE <br /> �vee��r au.v�r�r� C,�►�, �tM�ca►� e,►�, �H a�mas �fts��r-�c <br /> CONTRACTOR A�DHESS ZIP COMTH.UCENSE• <br /> PHONE�l�, �,.�s'QZ�S 7B �W�RV� �ir�G�W/+ ( PL��� 1 /N� <br /> '�J� i <br /> ppnPO3ED USE OF BUILDING Bullding I"1 Mechanica HEAT SOURCE <br /> PERMIT Combinelion � � Plumbing WORK Altera�ion nc <br /> ��y�/� TYPE Demolllion U Sign TVPE Naw Oas <br /> (7r rla� Sp�inkler RspsiqMeint. Other <br /> CONTRACT PRICE OF WORK� 2G�� �0.� CITY OF EVERETT LOCAL SALES TAX COOE 18�t0b <br /> /�v <br /> WORK DESCRIPTION <br /> -��,►�nt'r (M PR�v��'r" Fee. St�,Qy-�ns .�� � oPF��, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF RXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> i�ATHTUB _ FORCED AIR SYSTEMS <br /> � IAVATORY(WASH BASIN) _ HEAT PUMP <br /> OWER � _ UNIT HEATERS <br /> � KIT EN SINK 8 D1�POSAL CLOTHES DRYER <br /> � _ DISH SHER � RANOE HOOD <br /> U1UND TRA WATER HEATER <br /> CLOTHES HER � METALFIREPLACE/STOVE <br /> URINAL y FIREPLACE INSERT <br /> ' DRINKING OU TAIN OAS FIREPLACE ' <br /> FLOOR D AIN �AS RANGE <br /> BACKF W PREVE TER _ GAS PIPIyG <br /> � SINK ERVICE/BA OP/ETCJ HAU �FAN <br /> _ OTN _ OT oesr /ev�LG <br /> I HEREBY CERITIFY TF1AT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TH�SAME TO BE TRUE ANO CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF TNIS PROPERTY TO PERFORM THE WORK FOR WMICH APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> /jq,� '����'�P� 7�1/�03 <br /> i S1g�aWre of er `ontra /Authonzed Agen� � ale �/L <br />