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F�=RMIT APPLICATI��N <br /> CITZ' OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS � R PARCEL TAX I.D.q PERMI7 s <br /> / l�l � �" �inr Urc'v Dr� ✓'� � 3 � OD DO � <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER / ADDRESS ZIP PHONE <br /> )�� t�2c'S �.3/d /3 �/ h Sc✓ E✓Crf� �/g2Uk�S'^/227 <br /> TENANTNAhiE CONTA NAME PHONE <br /> /�-1 , k l Nd w,rc I �i2 s-3 s3 —�t�7f <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE M <br /> ��ii TaN�SUr� n� ,��� f �N� ? <br /> PHONE ��� _ 9Sl� ��Qp` <br /> / <br /> PROPOSED USE OF BUILDING Buiiding fl Mechanical n Addition HEAT SOURCE <br /> PERMIT R Combination �_� Plumbing WORK [� Alteralion � Eleciric <br /> TYpE D Demolition U Sign TYPE D New Gas <br /> IU Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK 9q O DU, �'(J CITY OF EVERETT LOCAL SALES TAX COOE IS 3705 <br /> .J / <br /> WORK DESCRIPTION / 7 / S� « � �uL � l✓�/�2 �'�r✓r I �� <br /> f'P7 � oF1' U�d /. uo/'�w, , <br /> � R�, R��f <br /> � ��t �17���r t�it�7 <br /> C <br /> PLUMBING MECHANICAL <br /> iN0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUO FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES ORYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY • WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> 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 /> I HEFEBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF W WS PND OFIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfFIER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEAMIT DOES NOT PRESUME TO GIVE AUTHORIT`f TO VIOL4TE CF CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPEAN TO PERFORM THE WORK FOR WHICH APPLICATION�S MADE AND I C(.''1PLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 FCW AND 296.200 WAC. <br /> �. '- �� <br /> Signalu af OsmeU onlractor/Auihonzed Ayent �' �e <br />