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F"._RMIT APPLICATI �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT d <br /> i �sc y boK�s ,��,� �`Ul -� � I - ov <br /> IEGA LOTNO. BLOCK TflACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> Lcr, Tu.� z - l6'G• p G�alfrs A�c /�fr�i aSoZ-� ,39 }� <br /> TENANTNAh1E I CONTACTNAME PHONE <br /> CONTRACTOR �✓t�re<�+ �7�<fe AO�RESS ZIP CONTR. LICENSE k <br /> ��.ut��,i� `�i .�o !�„�, fi� Ec��R�ssc a.�� <br /> I P40NE ��� �`�lA� <br /> � 35�.-3iiy 46aci <br /> ; PROPOSED USE OF BUILDING Building I� Mechanical 4dtli�ion HEAT SOURCE <br /> I PEHMIT R Combination �-� PI9m6ing WORK R Alteraiion D Electric <br /> TY?E D Demolitian LJ Si n TYPE D New D Gas <br /> i U Sprinkler � Repair;Maint. U Other <br /> ICONTRACT PRICE OF WORK 3�0� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> � WORK OESCRIPTION <br /> I �' -���.-, ��l ,�. -�• <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TVPE OF FIXTURE OR ITEM <br /> WATER CLOSET A!C—A/HANDLING UNITS <br /> I BATHTUB f FORCED AIR SYSTEMS <br /> ! LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYEF <br /> I DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER META�FIREPLACE/STOVE <br /> i URINAL FIREPLACE INSERT <br /> I _ DRINKIN3 FOUNTAIN _ GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING I <br /> SINK (SERVICE�BAWMOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEFEBY CE'nITIF'f THAT I HAVE READ AND EXAL7INED THIS APPUCATION AND KNOW THE SAh1E TO BE TRUE AND CORRECT. ALL II <br /> PROVISIONS CF WWS AND OFIDINACES GOVEFNING THIS TYPE OF WORK WILL BE CO�dPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. ?HE GRANTING OF A PERIdIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLiTE OR CANCEL TNE PROVISION OF ANY OTHER <br /> Siq�;^pR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> O�VNER OF TH:S PROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS M1fADE.4ND I COMPLY WITH THE STATE <br /> CONTFACTORS LAW 18.27 RC'N AND 296.200'NAC. <br /> `7�,.�,,,,,,� 1//3 v 3 <br /> Sign�ure �I Ownerl,� ntractcuAuthonzed Agent Date i <br />