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� =RMIT APPLICAT( �N <br /> CITY C1F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.O,ff P I7 <br /> 4 3 r 5 R,o� ,� „�„y ,D� ��D�b�'b� ��-- <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> /�h-, N4ii y3�s /P,dy�...o.� p. ��ao3 yaS-aSs-3Gav <br /> 7ENANTNAME . I CONTACTNAME PHONE <br /> CONTRACTOR �������^ S>nf. ADDRESS ZIP CONTR. LICENSEM <br /> �/e4f'C AI� iGii .� mo..�� G.�� /�- <br /> PHONEy35_ �SJ ,J��y E.t,.�V 9fr�0� ��dd fGE4GSS03.Jp <br /> PROPOSED USE OF BUILDING Building D�G Mechanical I'"1 Addition MEA?SOURCE <br /> PERMIT Combination ��_� Plumbing WORK II---�( Alleration Electric <br /> q TYPE Demolilion �, Sign IYPE �,..) New . �Gas <br /> N e5i Sprinkler L� Repair/Meint Other <br /> CONTRACT PRICE OF WORK a f�S, CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ._.�.�J� �?. <br /> � PLUMBING MECHANICAL <br /> INO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> I _ WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> ' LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOV�ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HO00 <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> � URINAL FIREPLACE INSERT <br /> DFINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER 1_ GAS PIPING <br /> SINK(SERVICE/BAR/MOf'/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> -- — I <br /> I HEREBY CERITIFY?HAT I HAVE READ AND EXAMINED THIS AP?LICATION AND KNON'THE SAME TO BE TRUE AND CORFECT. AlL <br /> PROVISIONS OF t.,1W5 AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEflEIN OR <br /> NOT. THE GRANTI�!G OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHCRIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIUN IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS L,1W 18..7 RCW AND 296.200 WAC. <br /> Q `�o-w�A , y as-o� <br /> Sign re of Ownerl actodAuthonzed Agent Date <br />