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��RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PF�RMIT# <br /> �yas� w���,�t .�z o� �i37o3'7901 0� L�o� - ��l <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. r�� ��I�qtw <br /> OWNER ADDRESS 21P PHONE <br /> C� e.;r .S oH cs o� /9d� C.i��..,�.� /�,,� 9�c�/ <br /> TENANi NAME CONTACT FOR PERMIT PHONE <br /> �i�t.�r�, �'�or�- `/�5')34S 9S 7 7 <br /> CONT ACTOR ADDRESS ZIP CONTRI.LICENSE N <br /> 5�,.4 Flan,� /�t..,�J< I a,Q����- u��d �t�✓Jtin l� .4��l�l •. 9sZ3�.i S�O..Y l,r o�s•�f- <br /> PHONE <br /> PROPOSE�USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT Combinalion ,R�( Plumbing WORK Alteration Q Electnc <br /> �jc�✓�i9�L IYPE Demolition U Sign IYPE � New �j Gas <br /> Sp�inkle� Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK �y�7;�v-"- CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORKDESCRIPTION �h �� �C��ti52 L�� �� I�d' • �� ^a� <br /> WhS4C� 4r�� �+`�Ci- �h 5'fivwq-�_ <br /> V <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 8 DISPOSAL CLOTr1ES DRYER <br /> _ DISHWASHER RAN.;E HOOD �, nn� <br /> LAUNDRY TRAY ✓ WA'i ER HEATER -�(/C <br /> �`� CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER �i GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I I HEREBV CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND URIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIi DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPER7Y TO PERFORM THE INORI(FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827�W-PJJD 296.200 WAC. <br /> �5�� s��� �i%�/o� ,�z <br /> SignaWre of O�.vner/ContractodAuthorized Agent Date <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED G O 3� � `� I I <br />