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� P`� RMI�' APPLICATIL �� <br /> CITY OF EVEREIT PERfJIIT SERVICES <br /> 3200 CEDAR S�REET, EVERETT, WA 98201 ' <br /> 425-257-8810 - FAX 425-257-8857 <br /> JC C�?! i�_OU� <br /> SITE ADDRESS i .� n PARCEL TAX '.D.# PERMI7 s <br /> � ��` �S C�. <br /> IEGA LOTNO. BLOCK TRACT <br /> DES(:. <br /> OWt1ER ADORESS ZIP PHONE <br /> �E�� C��,�y � c.�. i��k �71(� (-^u�r<� � y.�6 y1�'as�z 3��� <br /> TENANT NAME , CONTACT NAME PHONE <br /> ���. ���,�,j� I�J�IZ11-�I�.irS I (,���<��� �. s��, ��-» �y��»sy-ss� <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE p <br /> PHONE <br /> PROPOSED USE OF BUILDING I� Building I"'1 Mechanical Addition HEAT SOURCE <br /> PERMIT KI--( Combinalion �_� Plumbing WOqK IR—( Alleralion Q Electric <br /> TYPE �/ Demolition LJ Sign TYPE �j New I �j Gas <br /> — U Sprinkler U RepaidtdainL U Olher I <br /> CON.qACT PRICE OF WORK f r ��� I v voi CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i�o a <br /> WORN DESCRIPTION <br /> �l�i.,�.'�+B��Ub Cot�(�c�-� �02 �� -rc�,4� <br /> iPLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI7CTURE UR ITEM <br /> � l,� WATER CLOSET A/C—A/HANDLING UNITS <br /> ' _� BATHTJB FORCED AIR SYSTEMS <br /> � LZ L4VA70RY (WASH BASIN) HEAT PUMP <br /> �_ SHOWER UNITHEATEAS <br /> � KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> 4 DISHWASHER RANGE HOOD <br /> LAUNDFY THAY � WATER HEATER <br /> N CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPI.ACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEiBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEFEBV CERITIFY?HAT I HAVE READ AND ExAIdINED THIS APPLICATION AND KNOW TNE SAME TO B[TRUE AND CORRECT. ALL � <br /> PROVISIONS OF L11VS AND OHIDRIACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEPEIN OR <br /> NOT. THE GRANTING OF P.PERtdIT DOES NOT PRESUMF_TO GNE AUTHORIIY TU VIOLATE OR CANCEL THE PROVISION OF AN'I OTHER <br /> STATE OR LOCAI LAW REGULATING CONSTRUGTION OR THE PERFOPMANCE OF CONSTRUCTION. THAT!AM AUTHORIZED BY THE <br /> OWNER OF TfiIS PROPERN TO PERFURM THE WORK FOR WHIGH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONT CTORS LAW'827 qCW AND 296.200 WAC. <br /> Y �' <br /> % <br /> � ...���- /o j q�o z <br /> i�ure I Owr rri'oNractor/Aulhonzed Agen! —� Date <br />