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� �RMIT APPLICATIJN <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.M PERMIT a <br /> ��aa � St $ d3o3-o3 °► <br /> LEGA LOTNO. BLOCK TflACT <br /> DESC. <br /> OWNER AD�RESS 21P PHONE <br /> � r r a ti /���u�-v�- <br /> TENANT NAMG CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRE55 ZIP CONTR.UCENSEN <br /> PHONE /����, <br /> C. <br /> PROPOSED USE OF BUILDING I pERMIT R Combination u S 9n b"19a' ITMpE K Repair/MainL HEAT SGes CE <br /> �� � TYPE Demolition U R�-( <br /> � B Sprirk�er LJ LJ Other <br /> CONTRACT PHICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3/05 <br /> WORK DESCRIPTION <br /> l / � <br /> �/4�c�L�. -�t�r- S�i -�2t c��� C� lav.3 -C� •- G�� <br /> / <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATOFY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR CRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIP�NG <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> i — — <br /> i — — <br /> I HEREBY CERI7IFY THi.T I HAVE READ AND EXAMINED THIS APPIICATION AND ICNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE Oli LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS fAW 1827 RCW AND 296.2001NAC. <br /> I Signaturo ol O�vnedContractodAuihonzed Agent Oale <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />