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��RMIT APPLICAI�..�N <br /> CITY OF EVERETT PERIVIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.+1 PERMfi• <br /> � � o � q Av� SE• /'� � o�-o��. <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWN��`� �� �Q� A/��3 ZIP PHONE <br /> �✓ �A.�irc �. CI�d7 <br /> TENANi NAME I CONTACT NAM PHONE <br /> V��Q� AYC l/�d�� <br /> CONTRACTOR ADGRESS ZIP CONTR.LICENSE• <br /> E��22�'ta� �S��te ����E I6(l �Wl�n.uE(�it�Qt, 4�zo1 E�.cat65soZzoT <br /> PHONE/.,ZS� Z�Z' 3II� <br /> /�fi <br /> k-- ��! <br /> PROPOSEC USE OF BUILDING Building IK mechanical A dition HEAT SOUHCE <br /> PERMIT R Combinalion �_� Plumbing WORK Allera�lon �ric <br /> TYPE D Demolition LJ Sign TYPE New Ges <br /> U�� 5'(j�,f,. C� Sprinkler Repei4Maint. Other <br /> CONTRACT PRICE OF WORK /�J�n� CfTY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> G l/ <br /> WORK DESCRIPTION <br /> �o�'�� �,�--� <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FlXTURE OR REM NO. TYPE OF Fll(TURE OR REM <br /> WAT�R CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER I <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR ORAIN _ GAS RANGE <br /> BACKF�OW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN C����a, <br /> OTHER _ OTHER <br /> I — <br /> I <br /> ; I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO QE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF�40RK WILL BE COMPLIED WITH\VHEfFiER SPECIfIED HEREIN OR <br /> �� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AU?`IORITY TO VIOUTE OR CANCEL THE PROVISION OF ANY OTHER <br /> . STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TkAT 1 AM AUTHORIZED BY THE <br /> i OWNER OF HIS P PEFiTY TO PERFORM THE R WHICH P�PPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> iCONTRACT RS W 18.27 RC A D AC. <br /> , 7 ZZ-aZ <br /> � Si natur ol OwnerlConiractor/Authorize Date <br /> 9 '/� <br />