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t <br /> �RMIT APPLICATI�N � � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 ^ <br /> l��i � r7� - !>���' <br /> SITE ADDRESS PARCEL TA%I.D.R ���0} <br /> l7 .��5 �P,O• �-1 -000- t�3o- o � <br /> LEGA LOTNO. (apT BIOCK TRACT <br /> DESC. a � o - <br /> OWNER ADDRESS <br /> 21P PNONE <br /> Qc�la�ci �.�n1�e�.�r�`1..� �"IU�a. 35 � �c �C q$o�a �115 "l43 l'1l8 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR � � ��I�� 4 ,�� �� (g <br /> ADDRpSS ' AP CONTR.LICENSEM <br /> A�a�izEv��R►�s 1�-.►�c. <br /> PHONE <br /> _ �1d5 - Z�l3 -Il lq l l o3a -'3s�-�p�S� `��o��. �DAIR��-o3dc ► <br /> PROPOSED USE OF BUILDING I I;ygwlding fWM echanical Addition HEAT SOLpCE <br /> S�(t��¢. �o-nn�l PERMIT KI-.( Combination LF�L/ Plumhing WORK �Iteretion Electric <br /> ,,L���-� TYPE �...) Demolilion U Si9n 1YPE aw es <br /> U Sprinkler Repair/Maint. I �Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SpLES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> �lc�.uJ i��xaA>- �� alb0 <br /> PLUMBING MECHANICAL <br /> N0. � TYPE OF FlXTURE OR REM NO. TYPE OF FU(TURE OR ITEM <br /> � _'� WATER CLOSET A/C-A/HANDIING UNITS <br /> i � 9ATHTUB ._.L FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � SHOWER <br /> � I KITCHEN SINK 8 DISPOSAL UNIT HEATERS <br /> ; � DISHWASHER � CLOTHES DRYER <br /> f RANGEHOOD <br /> iLAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER _ MEiAL FIP.[PLACE/STOVE <br /> � URINAL FIREPLACE INSERT <br /> I _ DRINKING FOUNTAIN y GAS FIREP'ACE <br /> _ FLOOR DRAIN y GAS RANCE <br /> � _ BACKFLOW PREVENTER GAS PiPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) ,� EXHAUST FAN <br /> � _ OTHER _ OTHER_ <br /> � — <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> I PPOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL DE COMPLIED WITH WHEYNER SPECIFIED HEREIN OR <br /> • N07. THE GFANTING OF A PERAIIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THF PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF 7HIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTOFS LAW 18.27 RCW AND 296.200 WAC. <br /> � . . ��ea�,. .-�,,,,�,,,, . �(avlo� +: <br /> S�gnawre oi vwneriGonlractor/Aut�nzed Ag2nt pe�e �/� <br />