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AERMIT APPLICA�"9N <br />CITY OF EVERETT PERMIT SE;RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-9810 - FAX 425-257-9857 <br />SI7E ADDRESS <br />��.�f� �c'� ( ,S� <br />LEdA LOT p10, <br />DESC. f <br />OWNER <br />����r�• ' �TF'ilUl /i/. <br />TENANT NAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDINO <br />CONT�T PRICE OF WORK <br />WORK DES�RIPTION <br />�r+'.v�c" � 111 C� <br />� <br />� <br />PARCEL TAX I.D./ �EqMR � <br />G'�/��G'-Cx-r'—fXf1'-C7l> I/ i,!'✓;� <br />BLOCK I 7RAJi9 iJ � �'�, <br />jc.�`<-filh� lx <br />ADp RESS <br />C Il S+k �'•'�J <br />�c' '�'+�%c_ y��,> s� <br />ICO ACTNAME <br />//�U,.!/ ���/l�r-� <br />ADDRESS <br />� Buliding Mechanlcal <br />PERMI7 Combinalion � Plumbing W� <br />TYPE Demolilion Slgn 7y <br />Sprinkler <br />TVPE OF FlXTURE OR REM <br />WATEq CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISPOSA� <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />07HER <br />yls-3�y os �3 <br />PHONE <br />��n `�.�%�S; <br />LP CONiR. UCENSE I <br />�y.dn yy, <br />�Adtlllion I HEA7 SOUR�E <br />Alleralbn � Electrk <br />New Oea <br />RapaidMeinl. Olher <br />CITY Of EYERETT LOCAL SALES TA% CODE IS 3f05 <br />NO. I TYpE OF FlXTURE OR REM <br />—L <br />! NC: - A/HANDLING UNITS <br />F'1RCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CIOTHES DHYER <br />RANGEHOOD <br />WATER HEATFR <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />QAS FIREPLACE <br />GAS RANOE <br />GAS PIPIN�1 <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERI7IFY THAT I HAVE READ AND EXAMI�lED THIS APPLICATION AND KNOW THE SAME 70 BE TRUE AND COHRECT. ALL <br />PROVISIONS OF LAWS ANO OFIDINACES OOVEFNIN6 THIS TVPE OF WORN WILL BE COMPLIED WIiM WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GHAN71N0 OF A PE7MIT DOES Npi PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PHOVISION OF ANV OTMER <br />STATE OR LOCAL LAW REGUVI7INO CONST�iUCTION OH TNE PERFORMANCE OF CONS7RUCTION. THAT I AM AUTHORIZED BV THE <br />OWNE F MIS PHOPERTY TO PERFORM THE WOHK FOR WHICH APPLICATION IS MADE AND I COMPLY WITM TME STATE <br />CONT RS Lf1W 18.27 RC AND 298.200 Wp�, <br />/ ,��/ �/ <br />�� !� l'�/i",:�f �`�-- � lC� -r� <br />igna, re o wner/ onlraclor/Aulhoriie penl ete ,'//, ,1 <br />.l� <br />