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� � cRMIT APPLICAT: )E�I � <br /> ' CITY (�F EVERETT PERMIT SERVICES <br /> I �i 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE A�DRESS PARCEL TAX I.D.!I PEF�MI7 a <br /> �/i2 170 ? �� %Uf' 1b�7/v -d9/ <br /> LEG4 LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS 2IP PHONE <br /> � �'/'� ;� ��°%%t�r ��33 C'��iv � �r�'°,�l �63 �y�s)�S� G2gy <br /> TENANT NA�.1E , I CONTACT NAME PHONE <br /> /�����£ <br /> %I CONTRA�R n / �- ADORESS 21P CONTR.LICENSE K <br /> f77TL'uz ir /� � <br /> ���b�ho,� 5�;,:.Z�y '�— <br /> PHONE �//�yn" � <br /> i �Str3 iS'r^—�}�c NE Rc�m�n� ��Y, ��60� o� Ni.LZA �RS9� 71. � i <br /> PROPO/SED US/E OF BUILDING X Building Q MechaniCal Aadrtion HEAT SOURCE I <br /> `lNT/�l�/fO (/S�� �?S ��fs PERMIT R�-( Combination I ) Plumbing WORK Ailerauon �lecmc <br /> TYPE �.,/ Dem01i i0n � Sign IYPE � New � Gas <br /> � � ,��,N J / L) Sprinkler Repaidt.faiN. I Other <br /> /�/�F' C. �F /\YS�'''�" lAt/bl� <br /> CONTRACT PHICE OF WORyV /���,V �' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> . � / <br /> �� WORKOESGRIPTION / �� C !{} "� L�U/�g/I'T `�P/'IfU(� S��C'�G�I�II �' "n� <br /> /}�S��rs��io,v or �cPP /1m�7>�� S�tGQ�v <br /> ��L.s.�/t�� 7`!,� /��c�/���:ft�,n%Q�f7`Ai/c� �`��G'�'�y�N�/ i�� c�of,r�� �iAv <br /> i�-;ff �G�;l � �' <br /> !7^S�'iu�f MECHANICAL <br /> ' PLUIIE8ING <br /> NO. TYPE OF FIXTURE OR ITEM11 NO. TYPE OF FIXTURE OR ITEM <br /> VJATER CLOSET _ A!C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS I <br /> LAVATORY (WASI-I BASIN) _ HEAT PUMP <br /> SIiOWER _ UNIT HEATERS <br /> KITCHEtJ SINK 8 DISPOSAL _ CLOTI-1ES DRYER <br /> DISHWASHER RANC;E HO00 <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FiREPLACPJSTOVE �� <br /> URINAL _ FIREPLACE I�!SEF1T <br /> ^a'NKING FOUNTAIN _ GAS FIREPLACE <br /> I r�'OR DflAIN ,_ GAS RANGE <br /> 9A�<FLOW PREVENTER _ GAS FIPING <br /> __I ��NK �SERVICE/BAF/MOPIETC.) _ EXNAUST FAN <br /> _.� �THER _ _ OTHER _ <br /> I - <br /> — I <br /> — I <br /> I HEREFV C�9ITIFY'NAT I HAVE flEAD AND EXAMIVED THIS APPLICATION AND KNOW THE SAME TO BE TFUE ANO CORRECT. ALL I <br /> PFOVISIi1N5 OP UK'S AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN GF <br /> NOT. iHE GR�NTING OF A PER�dIT DOES NOT PRESUh1E TO GIVE AUTHOR1IY TO\90WTE OR CANCEL THE PROVISION 0" �1NY OTHER <br /> STAT.ri OF7 LCCAL L1LV FEuULr1TING CONSTRUCTICN OR THE PEFFORh1ANCE OF CONSTPUCTION. THAT I AM AUTHGRI2FS:'�BY THE I <br /> OWNEii CF THIS PRCPEflTY TO PERFOR�.1 THE WORK POF WHICH dPPLICATI0IJ IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTCRS LAW 1827 RG'yv AND 296200 WAC. 'i <br /> c �. �� �� -� G� <br /> '� L'�f ���f/'i�/ � � � ' � <br /> Signatur2�ot OwnerlConlract /Aut onzed Agent Date �(a <br /> I <br />