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RCRMiT APPLICAT�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS 3Q� �q 4 S PARCEL TAX I.D.N PERMIT w <br /> r• � 4'�CO"�14— val— �DO$' .L`�dil-oD �-. <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER A ORESS ZIP PHONE <br /> 5�a��s� `C�n1� 3�tD3- M+�.ner' AJ�., 4a,5'— ��3344 <br /> �o�cl,,,o.�c. ���t�s�on �. Ffar <br /> TENANTNA CONTA NAME PHONE <br /> I j-e.� 06oy�t �{�-s-388"379� <br /> CONTRACTOR W Ll'� , ,(��C g��� ADDRESS LP CONTR.UCENSE Y <br /> .331i�Sc �i w( <br /> PHONE��-C��]�-- 4�($5 NC• WN "r84e`t <br /> Wr►�D�C(.'� 10�� <br /> PROPOSED USE OF BUILDING � f� Build(ng n Mechanicel Additlon MEAT SOURCE <br /> I PERMIT �� Combinalion K Plumbing WORK Aiteretion R Eler.tric <br /> TYPE e,j Demolilion �� Sign TYPE New �j Gea <br /> U Sprinkler Repair/Maint. LJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION . • �I� <br /> , l�� Sh <br /> � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTUPE OR REM NO. TYPE OF fll(TURE OR ITEM <br /> _ WATERCLOSET _ A/C—AMANDLINGUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> i _ 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 /> � <br /> I <br /> I <br /> � I HEREBY CERITIFY'HAT I HAVE READ AND EXAMiNED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS AND OqIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL lAW REGULA?ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ; OW R OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY Y�ITH THE STATE <br /> � CO�CTORS LAW� R AND 296.200 WAC. <br /> � � �� � 'd�- <br /> �----� <br /> ISignalure of O UContractodAuthonzed Agenl Data <br /> I <br />