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i�cRMIT APPLICA.T�N <br /> CITY OF EVERE:TT PERMi i SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257•8810- FAX 425-257-8857 <br /> SITE ADORESS P.QRCEL TAX I.D.# PER�AiT u <br /> '�2 3 ���S P�- M ��,� -Q�3 <br /> LEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> uWNER ADDRESS ZIP PHOIJE <br /> �J �',� n 5� -� ��I,, r. � `� �Z � v`� PC� <br /> TENANTNAME CONTACTNAME PHONE <br /> i <br /> CONTRACTOR ��jDLJ'� l�� ADDRESS �� IZS13,�/ ry� Z1�IOP CONTR.UCENSEq <br /> /"� 1 I.l� G�e-�'G Y'� � pV O 2 <br /> i PHONE '! ZS� 7�I S— � b C7C/ ' <br /> � E,soLc�s�v�ZS � <br /> � PROPOSED USE OF BUILOING TYPEIT � Spnnkle�n n cl9n b n9al ITMPE Fepav/MainL HEAT SOO hRrIE <br /> I <br /> ICONTRACT PRICE OF WORK � �j/ G•�D� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> � — <br /> I WORK DESCRIPTION r� � / �� � /G'Az �' �� � (� <br /> 1 V l7 : > <br /> PLUMBING MECHA��ICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OP ITEM <br /> WATER CLOSET A!C–A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASN BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK S DISPOSAL 3 CLOTHES DRYER <br /> _ DISHWASHER �1 RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER � METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DFINKING FOUNTAW . GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER �Z GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTH[R OTHER <br /> i I ICGCoY CERITIFY THAT I HAVE READ 4ND EYAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS Of'LAWS ANC ORIDINACE:GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> NOT. THF GRANTING OF A PERMIT DOES�OT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PPOVISiO�OF ANY OTHER <br /> STATE OR LOCAL LAW R[GULATING CONSiRUCTION OR THE PERFURMANCE OF CONSTRUCTION. THAT I A1�1 AUTHORIiE�BY THE <br /> OWNEF OF THIS PFOPERIY TO PERFOFM iHE WORK FOF WHICN APPLICATION IS�dADE AND I COMPLY VJITH THE STP"(E <br /> CONTRACTOFS LAW 1827 RCW AND 2�6750 WAC. <br /> <.'1 .�� /�� ID �3i- OZ <br /> SignaWre o�O��vr eii o ra oriAuthonzed Ac�en� Dale <br />