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� tRMIT APPL[CATf.,lN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> � uC r <br /> SITE ADDRESS ,, PARCEL TAX I.D.N PERMIT M <br /> � �e c�C�3oa-ooa <br /> LEGA LOTNO. BLOCK TppCT <br /> DESC. <br /> OWNER ADDRESS LP PNONE <br /> '� � �C1 P f S� �'� ��� I �i.�f k��' /�.l'e ��02� � ,hls o�J 7.3CL5 � <br /> TENANTNAME I CONTACTN4ME PHONE <br /> CONTRACTOq ADDRESS ZIP CONTR.LICENSEN <br /> PHONE 0���J <br /> PROPOSED USE OF BUILDINC Building Mechanical Atlditlon NEAT SOURCE <br /> PERMIT R Combinetian R Plumbing IWORK R Alteration Q Electric <br /> TYPE D Demolition � Sign TVPE D New �] Ges <br /> S�i� U Sprinkler(x of heeas) D RepaidMeint. U Other <br /> CONTRACT PqICE OF WORK ��CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION <br /> 4 <br /> /� /u s � ,��LS-P�,..� ..� �P. <br /> f <br /> PLUMBING MECHANICAL � <br /> NO. TVPE OF FIl(TUpE OR REM NO. TVPE OF Fl7(TURE OR ITEM <br /> _ WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WqTER HEATER <br /> _ CLOTHES WASHER _ METAL FI9EPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HER�IN OR <br /> NOT. THE GRANTING OF A PERMI7 DOES NOT PAESUMF TO GIVE AUTHORIiY TO VIOL4TE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TNE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON7RACTORS�L�AW1�18.27 RC/yy-p1ND 96.200 WAC. <br /> � � L���v � V I 1 'v . (1{nd''� ��� �b �U � <br /> SignaWre of Owner/Contract r/Authonzed Agent Da e <br />