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��RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.A PERMI7 M <br /> o � 5 c�o �� c oa.oG <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. I 6� <br /> � <br /> OWNER ADDRESS ZIP PHONE <br /> �n�!1 'I]/i'�.rn �ntnnP D��S i7�i C�tl�r'72�J 23 I �� <br /> TEPlANT NAME CONTACT NAME U� PHONE <br /> .Sa�n-�,�Gts �ti�te�' I�'�v�n� as ou�v�,�l` uzs-asq ��,2 �J <br /> �Q' �t7[��1/� �--tJ�'J�D6'Gt� RE1 �� lu7S a✓ �(a2 CONTR.LICENSENO�IL I <br /> PHONE � """—' ""' ' <br /> � -' `�`[• D533 <br /> PROPOSED USE F BUILDING IQ( Building Mechanical Addition HEAT SOURCE <br /> � r PERMIT �� Combinetion �PlUmbi�g WORK � Alteration � Eleciric <br /> G��ec/1��( TYPE �j Demolition Sign i'YPE New Ges <br /> L� Sprinkler Repair/Maint. Olher <br /> CONTRACT PRICE OF WORK ��/ �«�G� 2J �/J9 CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> CJ 7� <br /> WORK ESCRIPTION <br /> tin �� M�b�-✓'`�f�� Gt� �� v�,,,5 `���, 9G� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF FUCTURE OR REM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> � BATHTUB �Sl..p,,; �,,2 _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> �,_ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHEa RANGE HOOD <br /> _ LAUNDRY TFAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOV!PREVENTER GAS PIPING <br /> _ SINK(SERVICElBAR/MOP/ETC.) _L EXHAUST FAN <br /> _ OTHER OTHER <br /> �HEREBV CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING T'i1S TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM17E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR�VHICH APPLICATIpN IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC'�ORS W 18.2 CW AND 296.200 WAC. <br /> 'I� ` �1i \_ I.�i��v�.l,�Aw� <br /> `A. <br /> SignaluTe ol OwnedContractor/AWhorized Agent Date � <br /> a <br />