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� �RMIT APPLIGATIJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STAEET, EVERETT, WA 98201 <br /> 425-257-8&10- FAX 425-257-8857 <br /> SITE AD�RESS I PA�iCEL TAX I.D.p pERMi7 x <br /> ' " � I Qoao7-oar� <br /> LE A LOTN . BLOCK TRACT <br /> DESC. <br /> O��r� � ^^ A n ^ ��+ .� pDDRESS ZIP PHONE <br /> ( (ilNvvl�'��i VI �3-3r�� <br /> TENANT NAME I CONTACT NAME PHONE <br /> CONTRACTOR ��^ n„ ADDRESS ZIP CONTR.LICENSE N <br /> �XJ V <br /> i <br /> PHONE <br /> PFOPOSED USE OF BUILOING I Building I� Nechanical Ad�ition NEAT SOURCE <br /> PERMIT R Combination �-� Plumbing IWORK R Alteration I � Electric <br /> TYPE D Demolition �-� D <br /> Ll Sign TYPE New Gas <br /> U Sprinkler � Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3f05 <br /> WORK DESCRIPTIOC� , <br /> M f1 1 I 1� IUsYW ��`--�� � <br /> � i U�i...� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. TVPE OF FI7CTURE OR ITEM <br /> i _ WATER CLCSET A/C—A/HANDLING UNITS <br /> ', _ BATHTUB FOFiCED AIR SYSTEMu <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIAEPLACE INSERT <br /> � DRINKING FOUNTAIN . GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAFUMOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERIiIFY THAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAM1iE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OFI�INACES GOVERNING THIS TYPE OF WORK WILI BE COh1PLIE�WITH WHEfHEfl SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERh11T OOES NOT PRESU�IE TO GIVE AUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHEA <br /> STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM17 AUiHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS h1A�E AND I COh1PLY WITH THE STATE <br /> CONT ¢TOFiS LAW 18.27 flCW AN a6.200 WAC. " � <br /> �rCl? N1,CPa1/ �.1/12C�,Q/�"L/ � �/2���i CJ� <br /> SignaWre ol Owner/Contractor/Aulhodzed Agent ate <br /> 1/Z <br />