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PC,RMIT APPLICATIC N <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.M PERMIT a <br /> �o�- �JSra� St,�s<t 5. w. p boo � �, v ��c7Lo- O�`� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �n_y+�Co2� {�(-ir27Z 2a�- �"� ST2c<,� �W Uc'vcxa�f p�,7o3 -�S�-2Sa.5 <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEM <br /> PHONE <br /> U7ti.P/t� <br /> PROPOSEDUSEOFBUILDING BUildltl9 � Mechanical Addition HEATSOURCE <br /> ���A,��� PERMIT R Combination Plumbing WORK Alteretion � Eleclric <br /> �F��U�•�C G n'PE � Demolition Sign IYPE New Ges <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WOHK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION . <br /> �I � � if ROt� i? < .. , �.� � 130� �<„� V, �_;t ic��_, + �/ �n'�� <br /> � k <br /> V <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fll(TURE OR REM NO. TYPE OF FIXTURE OR REM <br /> � WATEA CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> Y LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHEP. METAI FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUI�TAIN _ GAS FIREPLACE <br /> FLOOR pRAiN _ GAS RANGE <br /> BACKFLOW PRE�/ENTER _ GAS PIPING <br /> � _ SINK(SERVICE/BAR/MOP/ETC J EXHAUST FAN <br /> OTHER I OTHER <br /> � — — <br /> � — — — <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF!AWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRAtiTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> I STATE OR LOCAL LAW REGUTATING ONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPE TO PER O THE WORK FOF WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> , CONTRACTORS LAW 18. RC 6.200 WAC. <br /> � ��--�a-c�3. <br /> Signature of Ow o ractod orized Agent ate � <br /> ��� �� � �'� `/z <br /> � <br />