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I��,RMIT APPLICATI�UN <br /> CITY �F EVERETT PERMIT SERV�CES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRES3 PARCEL TAX I.D.# PERhtIT a <br /> 3�i5- � f�ov� �2, �3i - <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS 21P PNONE <br /> � �—OkP�t� �3�'IS `J'(�e'Y� 64-1•� �So�3 ��S ��'.�-S"8�� <br /> �N PMONE <br /> TENANTNAME CONTACTFORPERMIT <br /> — ��� L�k�� �Izs 3ss-a$g ! <br /> ADDRESS ZIP CONTR.LlCENSE N <br /> CONTRACTOR�'N�-�� �O�(J(�-e I�TS Pr0 , PIG�X I S 3(� ENPRGC.'�QS�J � 1 <br /> PHONE �,��- s-r�J�S �F} q�a ss <br /> PROPOSED USE OF BUILDING I"") Building Mechanical �Addition I HEAT SOURCu <br /> PERMIT K Comhinatio�Plumbing WORK Alteratlon � Electric <br /> TYpE �__t Demolilion U Sign TYPE New Gas <br /> ,,�;�1� {� ,,,,; 1 u Sprinkle� Repalr/Malnt. OMer <br /> CONTRACT PRICE OF WORK a OG, �� CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> WORK DESCRIPTION <br /> �.e����� EX � s��'% C� �L'c � ic wa 'T�r �I.ea'�e /, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR 17EM <br /> WATER CLOSET(TOILET) _ A�C—FUHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> IAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER R4NGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPIACE INSERT <br /> ORINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/h10P/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SA�v1E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TFiE PROVISION OF ANY OTHER <br /> STATE OR LOC�•L LAW REGULATING CONST CTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 0"THE <br /> OWNER OF TFIIS�PROPERTY TO FOR , F,�WORK POR WHICH APPLICATION IS MP.DE AND I COMPLY WITH THE STATE <br /> CONTWC S�LA ^7B27frC 296 0 AC. <br /> � � ;� ,:� � �� /D -3-d <br /> Si�n ur of Owner/Fontra or u 'zed A� t Date <br /> DEBI 8 CREDIT CARDS ARE NOT ACCEPTED 111p j 1 U"�� 7 <br />