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' ; <br /> �'�RMI�' APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 22U0 CEDAR STREET, F_VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> �cJ y� — 3v <br /> SI7G ADDRESS i PARCEL TAX �.D.# r�ekn�ir= <br /> -t�1a� - ' �/rXo - s <br /> �7lti"-=��.--�vQ.ty.--_. -�(1L�c�'E �c,3�tao -oc,c -os�� - oi L 7— � <br /> ..5.:��1 LOTNO. i eI.00K TRACT <br /> =s��l �.ab$P Ot�O�d � — <br /> OWNER ADDRE55 ZIP PH9NE <br /> _ d�c���z��c�,�2�ses Lw »o�a-3s��� � s� 33�.�� �cgo��. �as-��3 <br /> TENANTNAME CONTACTFORPERM17IT PHONE L'�l <br /> 1....ytill..es5t� �-las - ��t3 -��tcg <br /> COIlWiRACTOR ADORESS ZIP CON7ft. LICENSE�J <br /> It�'0.l2CY1-�-1.�J�.IS•z�� Ll-C l'i0�81-3��Ue-SE 6o-Ih� g�e��7- a9a-�.a.�� 3��i <br /> PHONE <br /> PRGPOSEO USE OF�UILDING � ���uilding rIII---t,,,✓���Mechanical FaCilion HEAT SOURCE � <br /> ,,`,���� �„�_�-, / „ PERMIT �ombinalion �lumbing WORK Alteration � Elechic � <br /> v nr.�....- <br /> ��� 7YPE Uemoiitiun Sign TYPE ew �+'Gas <br /> Spnnkler RepaidMalnl. Other <br /> CONTRACT PRICE OF WORK f.ffY OF�VERETT LOCAL SALES TAX CODE IS 3105 <br /> IVORK D[SCRIPTION <br /> 13 eu� �L c��1� .I,o�,,,,�sv-� �.�.��-�� .�, aAa+c.--#� o1a-3 9 <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> b I! WATER CLOSET(TOILET) A/C-fvHFlNDLING UNITS � <br /> _�� BATHTUB _l_ FORCED AIR SYSTEMS <br /> _ � LAVATORY(WASH BASIN) HEAT PUMP <br /> �I- SHOWER UNIT HEATERS <br /> �_ KITCHEN SINK 8 DISPOSAL _�_ CLOTHES DRl'ER � <br /> _� DISHWASHER RANG[HOOD <br /> IAUNDRY TRAY _L WATER HEATER , <br /> _�_� CLOTHESWASHER _ h�tETALFIREPL:;CE'STr�re. <br /> i URINAL FIAEPLACE I�dSERT <br /> _I ORIPJKING FOUNTAIM _L, GAS PIREPLAC� <br /> FLOOR DRAIN _(_ GAS RANGE <br /> _ BACKFLGW PREVENTER � GAS PIPING <br /> SINK (SERVICE�BAR/MOP+ETC.) `j _ EXHAUST FAN <br /> __ OTHEP, _� OTHER ___ <br /> --� — - <br /> —� - <br /> -I I <br /> -9REBY CERITiFY 7HAT I H.'vVE REi,D AND EriFIdIIJED THIS APPUCATION iaNO KN01'Y THE SA61E TO BE TRUF..+NG CGRRECT. ��i_I. <br /> ��"��i51GNS OF L4W5 HN�ORIDINACES GOVERNING TH�S TVPE OF N�ORK VJ�LL 6E CCMPLIEO 1VITH IVHETHER SPECIFIED`ic`tLl��l�?��i <br /> � �7 THE GR4NTih:G OF A PERAtIT DOES NOT PRESUPdE TO GI�:=AUTNORITY TO VIOWTc QR CANCEL 7HE PROVISION OF%.Ni UTHER <br /> .'..= '.. ,_ .•�.. i 4„REGULITING CONSTRUCTION OR'HE PERFORPdANCE OF CONSTRUCTIO�. �N4T I Ahi AUTHORI:_ED B1' TN� <br /> _.. .-.: _ ".-�$:=:nFc�TY TO PERFORLI THE'A'ORI<FOR\VHICN APPLICATION IS AIADE AND I Ci�'.".PLY`.VITH THE STATE <br /> ; " ,.. _. ,. +9.77RC'f/AND29u._00'.VNC. <br /> "?A�...��.�.:: , �,- <br /> �� , �lo� <br /> �;nira`�f Ovmer,Contncecc%u;h�nz�::d F9a� Date �/2 <br /> ^F_�- ;? '�?cDIT �,'`•R^S ,\�E NOT ,?CCEP?�� <br />