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�.RMIT APPLICATIl9C.� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EV�=RETf, WA 98201 <br /> 425457-8810- FAX 425-257-8857 <br /> PoZ(a-oU5 <br /> SITE ADDRESS PARCEL TAX I.D.R ERMiT M <br /> WARa� A��'_ 000s6f9o13oo� o'L /d -po <br /> LEGA LOTNO. BLOCK TRACT <br /> oEs�. Z � e,�,� �ti� A 1� �J'c.,�ET� ►��►�o A-ez <br /> OWNER ADDRESS ZIP PHONE <br /> ME�3R S►�cP�n� 15a; WAtt�.�} q-�t� �t��.T 482c1 `�2S- 2S'Z- booS <br /> TENANTNAME CONTACTNAME PHONE <br /> M� SrFcOQAtD ..�nsoa �.a�y yzs-3�y- ys�o <br /> CONTRACTOR I ��� /'� ADDRESS AP CONTR.UCENSEII <br /> PHONE �SIJTSLI t..�.i'�rj lJ=^�'�s% 8Lo5-ba�' Jh�= S�s <br /> ��45�aLL[_ 99L�o h LG�Jq 9d <br /> PRUPQSE6 USE OF BUILDING I I") Building I"1 Mechanicel f"� AdC�tion HEAT SOURCE <br /> PERMIT K Com6inetion ��Plumbing IWORK �,Alleration �Electric <br /> S, � �'L TYPE �..( Demolilian U Sign TYPE �.� New Gas <br /> �J Sprinkler U qapair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> 6E4TN2oDN� jZECoNF=Gu�r�� OF I�x Naz S -- <br /> ' �1G..1 SNo�ci 57`a�` <br /> IPLUMBING MECHANICAL <br /> N0. TYPE OF Fl)�TURE OR REM NO. TYPE OF flICTURE OR ITEM <br /> j � WATER CLOSET _ A/C—A/HANDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 GISPOSH� _ CLOTHES DRYER <br /> i _ DISHWASHER _ RANGE HOOD <br /> _ LAUNORY TRAY _ WATER HEATER <br /> _ CLOTIIES WASHER _ METAL FIREPLACFISTOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST FAN <br /> _ OTHER _ UTHER <br /> I HEPEBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TP.UE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PiiESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br /> OWNEF OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH APPL!CATION IS MADE AN�I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> (— ���.�.-•-� � lD-2�I-aL <br /> Sign ure ol Ow edComractodAu�e�em Date <br />