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� <br /> PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> i2 � a� --d5 <br /> SITE ADDRESS PARCEL TAX�.D.# PERMiT tt <br /> ��z� s� Iv�l�ke ed �t� SI� -� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �e.re.� o- �J Kemp � ►lZo S;IverluKe,2d 98208 4Z5 308 94'04 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �bb�� .�e,+�se.n �z5 25q t�r�(o <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> CN �eat�ng �n� 1�15 3roadc,�a� q820$ CMHEAz�o95 �+ <br /> �2,"a5q (nrobW �y�,� <br /> PROPOSED USE OF BUILDING pERMIT R Sprinbi1ealion U F'ltl bingal WORK �( Fepa dMainL HEAT SO eRCE <br /> TYPE g Demolition U Sign TYPE �__� New �Other <br /> U <br /> CONTRACT PRICE OF WORK CITY OF EVERETI'LOCAL SALES TAX CODE IS�105 <br /> WORK OESCRIPTION <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEh1S <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SI�'K 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY J_ "✓nTER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER y� GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF INORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERfd1T DOES NOT PRESUME 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 /> � 'VNER OF THIS PROPERTY TO PERFORM THE WORK FOR IVHICH APFLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ,NTRACTORS LAW 1827 RC AND 296200 VJAC. <br /> � uL�. � , � a � � • �� <br /> Sic�n . re of OwneriContra Auth ed gent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />