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P�r2MIT APPLICATIC,�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADURESS PARCEL TAX I.D.# PE MIT# <br /> /' IS IZuc�� r- �Ve.. �l:3 S �y�}oQ`7000�I � 7- <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. ' ayy EV��f'l,� OiViJ'IA�� R <br /> OWNER AODRESS ZIP P yt� <br /> SA��e� � l.l:Th �k.�r.�d�- �.1� �'�cker- Au�huz �� 98201 �.s� - �3 I b <br /> TENANTNAME CONTACTiJRPERMIT PHONE <br /> �ci►r�Ca Sc.�w�i�� (2s)257- 13ib <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE /�, ^^q , / <br /> [ 1/!"/('/C/ <br /> PROPOSEDUSEOFBUILDING pERM17 � SPrlmkiieation [� S9mbingal I�E�Repar/MainL HEATSGeRInc <br /> l�r���� TYpE Demolition U <br /> Other <br /> CONTRACT PRICE OF WORK ����/ CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> CL' <br /> WORK DESCRIPTION . <br /> �rPort, R���;,,��- wo.11 a�a �ard s�A(�`Y'9 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C–A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHE�DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL - F�REPLACE�NSERT <br /> = DRINKING FOUNI'AIN ,/��� — GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER /� GAS PIPING <br /> _ SINK(SERVICE/BARlMOP/ETC.) �)Y � I EXHAUSTFAN <br /> = OTHER �� � = OTHER — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 6E COAtPLIcD WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERAIIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATF OR IOCAL LA1N REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORVED BY THE <br /> . OWNER OF THIS PROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STAiE <br /> CONTRACT RS LAW 1 27 RCW AND 296.200 WAC. <br /> t . � . '7'�Z^ � S <br /> Si ature Owner ontracrodAuthonzed Agen: Date ��/ <br /> DEBIT 1� CREDIT CARDS ARE NOT ACCEPTED <br />