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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 />22—C�lur��rEo f'3w� <br />ALr LOT NO. BLOCK <br />SON <br />TENANT NAME <br />PARCEL TAX I.D. M <br />TRACT <br />�'-i22-MUKi�,t-b I�� <br />CONTACT NAME <br />ISeoq -1 e� A� ,� <br />NrJ WA • ��o <br />PERMIT M <br />'.nSYvk- <br />PHONE <br />CONTRACTOR � ADDRESS ZIP CONTR. LICENSE N <br />Wlfhu.,� ��u.�.J� �d2tsr �or5ux C�15'1 ��n-+oNAS, �J�•�18o7J�-ol� <br />_.._..1 <br />USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�ktssi�►� <br />Building Mechanicat Addition NEAT SOURCE <br />PERMIT R Combination � Pium6ing WORK Alteration � Eiectric <br />TYPE � Demolition Sign 7YPE New Gas <br />Sprinkle� Repair/Maint. Olher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />i� 6V � G�/lfT�►iablt�+ I'fT <br />(.m.�ee. �is�n.� <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Nw� <br />►J <br />) <br />UP$fY1725 IIuA���^� � NG�1 ICIi 'f l.l`fNniJ/t� m— <br />NO. I TYFE OF FlXTURE OR REM <br />A!C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FISEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY 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 THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A RMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE O� CAL LpW RE�TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER THIS PrjcaPER T PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA T RS LA�/ �8.27 R AND 296.200 WAC. <br />�2—� -�8 <br />Date s� <br />�i� i� <br />