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����RMIT APPLICAT�. �N � <br /> T CITY OF EVERETT PERMIT SFRVICES � <br /> 3200 CEDAR STRFET, EVERETT, WA 982U1 <br /> 425-257-8810 - FAX 425-257-8857 <br /> � ' ,�� '-i :;,�. <br /> SITE ADDRESS �, PARCEL TAX I.D. # PERMn a <br /> r i L,!l ' � �' �,�{ � ��,1 r:�� ��T�f. � �.Q�'-i 3b�5� 10300 C�3�Z�0 <br /> LEGA LOT NO. BLOCK TRACT 2 ��I�^� <br /> DESC. .� ZCL �✓�' V(J <br /> OWNEF ADG�7ESS 21P PHONE <br /> � , ,�-c ;-- r� '. �� ,�-u�::_'� = 3`�1 •,-v>�r�o�wr�� �a �T w �, �Bd.�6: 3h� �4�`1 (�0�: <br /> TENANTNAME I CONTACTNAME PHONE <br /> Ilii:r�iftUr l�i-rHrc�zS ���0 J2'l t�O� �i <br /> CONTRACTOR AODRESS ZIP CONTR. LICENSE p <br /> _j��'�.<:� �..) fc�,1(-.lz.� n.r�Y�)^..�C2UrT.lON ��d�. WO�'J^.'�.�C�`I�4Q�^ C? q�d.�,;; 50t�1NWC��'.�1M� <br /> PHONE .� ��_ , <br /> ,_�;... <br /> .. � ,,;�'_ ! F„��.�. v <br /> I PROPOSED USE OF BUIL�ING fJ, Building fl Mechanical Addition HEAT SOURCE <br /> PEFMIT F{—{( Co���6ination K Plumbing WORK Alteralion rn�( Eiectric <br /> TYPE �f Demolilion LJ Sign T'PE ' New u Gas <br /> U Sprinkler Repairih1aim. U Other <br /> CONTRACT PRICE OF WORK ;� )�� q� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> / / <br /> WORKDESCRIPTION ;^ ��p`='�TV-�?�-r fJC='�-I ��.,F l� <br /> � -� i ,. ��� �li�� ' <br /> i <br /> PLUMBING MECHANIC:AL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> - WATERCLOSET A/C—A/HANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> i LAVATORY (\NASH BASIN) HEAT PUMP <br /> � SHOWER UNIT HEATERS <br /> _ KITCHEN SINK & DISPOSAL / CLOTHES DRYER <br /> DISHWASHER T RANGE HOOG <br /> I _ LAUNDRYTRAY � WATER HEATER <br /> CLOTHFS WASHER METAL FIREPLACE/STOVE I <br /> I _ URINP� FIREPLACE INSERT � <br /> � _ DRINKING FOUNTAW GAS FIREPLACE <br /> � _ FLOOR DRAIN _ GAS R.4NGE <br /> I BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/8ARlMQP/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREaY CERITIFY THAT I HAVE READ AND EXAh71NED THIS APPLICATION r1ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF lAWS AMD ORIDWACHS GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERtAIT OOES NOT PAESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCdL LAW FEGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AA7 AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TQ PERFORM THE'NOFiK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH 7HE STATE <br /> GONTRAC,TAORS L.4W 18.2? FC'JJ AND 296/.2010 WAC. <br /> 9 ._�I_Y��.J[' 11 .P/1/� 9 <br /> Si na ure of wneu ontrab iAuth rized A ent Date i/i <br />