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PC.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 /> SITE ADDRESS PARCEL TAX I.D.r 00 3`1'/O Oood 1 q@RMI7 M <br /> Ocyi:� 1 c � ,�� Moato -o3 � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. i I / .Z,QO 13I OC.1� ' <br /> OWNER ADDRESS �P PH�N��?T' 77T'S�� <br /> Gl�/�/I»> S C/ecr,uniz/�//s �.c. i� ia �m��u/d ,5��//s b2-f-�/��M�s i�u <br /> TENANTNAME �� COhTACTNAME , PMONE <br /> laJi/��.Ah� ��c�,e:e � �/� f�/ /�� 4�S iZ ti`� � s s i <br /> . ���� c <br /> C�FFORbAC3LE NE/�T/�G �'Lodl� ADDRESS ,�p�E �u�„�yy� 4ftof AF�oRRMC9S!/'<</ <br /> �� 3Sis 99� <br /> PHONE <br /> �l.'i � .347- OR� � <br /> PROPOSED USE OF BUILDING I� Building La-Mechanical �Addition HEAT SOURCE <br /> PERMIT �_� Combination �__� Plumbing WORK Alteralion Electric <br /> ��� �r � ; �l n•. c � TYPE �j Demolilion LJ Sign TYPE New s <br /> U Sprinkler Repair/Meint. O�her <br /> CONTRACT PRICE OF WORK �� , �� 3 v CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION 1�� 5 ��. � .�6�r n u c e a N rJ� s �p/� ��/ l�' � ' ••S f1'd►w� P r•P o.�e ti s <br /> ,,,dC s�lJbb�n� oJ� �o '-1 -����c� a�P\:�e 5 . <br /> PLUMBING MECHANICAL <br /> i NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> I _ WATER CLOSET A!C-A/HANDIING UNITS <br /> � _ BATHTUB �_ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRYTRAY WATER HEATER <br /> ' CLOTHES WASHER METAL FIREPLP.CE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> i _ DRINKING FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> SINK (SEFVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHEF <br /> I HEREBY CERITIFY'HAT I HAVE REA�AND EXAMINED THIS APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS ANO OFIDINACES 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 VIOL4TE OR CANCEL THE PROVISION OF ANY OThER <br /> STATE OR LOCdL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCIN AND 296200 WAC. <br /> /,�,�1�== ,9 /tl`�� /0"�3 " °2 <br /> Signature ol Owner/ContractodAulhonzed Agent Date <br /> �� <br />