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R :RMIT APPLICATI(- 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.N PERMI7� <br /> �� � � , �_ mo3oa -ors <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. I <br /> OWNER ADDRESS ZIP PHONE <br /> �T�c1 }��C;lacYl //7�3 ��"`� �r �' �dr�n' wa Qa�2os' <br /> TENANTNAME CONTAGTNAME PHONE <br /> —. `-�as ass�..��Z,3. <br /> CONiRACTOR U�lT�O SUSIell�3 AOORESS LP CONTR.LICENSEM <br /> 1021 Sv� KLc�in� oJA-Y Su�re w4 ��(3c/ Cln�esrY7o�G� <br /> PHONE S�`�'�+' wq. <br /> PROPOSED USE OF BUILDING Q Buiiding (� Mechanical D Addition HEAT SOURCE <br /> PERMIT �_) Combination � Plumbing WORK 1�Alteralion �Electric <br /> TYPE D Demolition LI Sign IYPE D New Gas <br /> S�rk.zlo C�cc. 1-�ME . U Sprinkler I U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK �S 33 � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION Zhu1'A�\�2CI C�S L�nL� Fr'OM (1lDIe2 '�j I.t)O.TC'.'L �4�1 `�r—v2l�4C� ' <br /> I PLUMBING MECHANICAL <br /> I <br /> � NO. TYPE OF FIXTURE OP.REM N0. TYPE �F flXTURE OR REM <br /> WATER CL0�8T A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> I LAVATOAY (WASH BAS�N) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WAl'ER HEATER <br /> CLOl"HES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL __ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER_ <br /> — � �l�� �JCnUCr_ <br /> I F'EREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SAME TU BE TRUE ANO CORRECT. ALL <br /> PROVISIONS OF LAWS AND OflIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEPMIT DOES NOT°RESUME TO GIVE AUTHORITY TO VIOL4TE CP CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNEP OF THIS PROPERTY TO PERFORM THE WOFK FOF WHICH APPIICATION IS MAOE P.ND I COMPLY WITH THE STATE <br /> CON CTORS LAW 18.27 RCW AND 296.200 WAC. <br /> o�n� � �hc�J � <br /> Signature of Owner/ConlractodAuthorized Agent Date <br />