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�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 ADDRE83 PARCEL TAX I.D.• PERMR M <br /> /1�'e'�.? 7"-` .�r.. .f.E E�.� Fr• 3 o3-C� 1' <br /> � �ar no. e�xK rw►cr <br /> DESC. <br /> OWNER e AODHESS �P PHONE <br /> �O.�Hi�lna Sin7en 4MR <br /> Core� IQ yrr�- /O/� 7�A�. S.E E'r+n�/r.x. 99�d �!/ts��65-ab f.o I <br /> TENANTNAME CONTACTNAME PHONE I <br /> I LJ er k � <br /> a�,.s� �a�a.,�,� S�MoM <��r�YB'�- 7J7 <br /> i <br /> CONTRACTOR ADDiiE38 nP CON!N.LICENSE N � <br /> PHONE <br /> �WKer <br /> PROPOSED USE OF SUILdNG Building 1�1'MecheniCel AddlUa� HEAT SOURCE S <br /> Ua <br /> PERMIT Combinetbn H Plumbing WORK � lUteretbn � Electrlc � <br /> tu TYPE Dem011tion U Sign TYPE New Ou 1 <br /> 5/ // Spdnkler RupeINMaIM. Olher ' <br /> CONTRACT PRICE OF WORK CfTY OF EVERETT LOCAL SALES TAX CODE IS�10b <br /> YYORK DESCRIPiION � <br /> ��l� in � <br /> PL'JMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM N0. TYPE OF FlIITURE OR REN ' <br /> _ WATER CLOSET A/C—NHANDLING UNITS I <br /> _ BATHTUB � FORCED AIR SYSTEMS � <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS � <br /> _ KITCHEN SINK 3 DISPOSAL _ CLOTHES DRYER I <br /> _ DISHWASHER _ RANdE HOOD <br /> LAUNDRY TRAY WATER HEATER � <br /> _ CLOTHES WASHER _ MEfAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN CiAS FIREPLACE <br /> _ FLOOR DRAIN OAS RANGE I <br /> _ BACKFLOW PREVENTER � CiAS PIPINO 1 <br /> _ SINK(SERVICE/BARlMOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> _ — I <br /> i <br /> i <br /> 1 HEHEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br /> PROVISIONS OF LAWS AN�ORIDINACES QOVERNINO THIS NPE OF WORK WILL BE COMPUED WfTH WHETFiER SPECIFIED HEREIN OR <br /> NOT. THE ORANTING OF A PEqM1T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Q(?CANCEL THE PROVISION OF ANY OTHER I <br /> STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE i <br /> OWNER OF THIS PROPERTY TO PEAFORM THE WORK FOR WHICH APPUCATION IS MADF_/WD I COMPLY WITH THE STATE i <br /> CONTRACTORS U1W 7827 RCW AND 296.200 WAC. <br /> i <br /> �o�3 � <br /> Sig ature o wned ontracrod uthoriz gent ate � <br /> DEBlT 6 CREDIT CAFtDS ARE NOT ACCEPTED ' <br /> 1 - - <br />