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a;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 /> - PARCEL TAX I.D.� PERMIT M <br /> SITE ADDFESU ��1 CL \ �,,�p� �,c�v I <br /> �J � L.Y�+ 'S.J�— <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � <br /> OWNEH ADDRES9 LP PHONE <br /> P(J� �►�.P�-tS�_S � �c. ��� � c3ak 39o4 , E�r5°zv3 4E�-4zz`K8 <br /> TENANTNAME CONTACT NAME ^ ' <br /> I �E T E_�C'-�NCIC�. �'ZS�^�` � -��� <br /> CONTRACTOH • ADDRE53 ZIP CONTR.LICENSE� <br /> � A�- E+��Q�,+3��� ,�-►.�c_ � �, 3c� 3404 �vr ��zo3 <br /> PM NE PA�J�Jy� OZ(o�� <br /> �as - -a-a — ��6� <br /> PROPOSED USE OF BUILDINO �ullding D MeChenlCel AAAitlon MEAT BOURCE <br /> PERMIT ombinatlon U Plumbing WORK Aliereibn nII��-( E=e..str� <br /> � F� �-yPE Damolillon U Sign �PE qepetrrMaim. v �+,^er <br /> Sprinkler <br /> CONTRACT PRICE OF WOFK CITY OF EVERETT LOCAL SALES TAX COCE 19 J105 <br /> WORK OEBCRIPTION 'Sq f�� 2 L � � <br /> v� <br /> — PLUMBING MECHANICAL <br /> N0. TYPE OF Fl:(TURE OR REM N0. TNPE OF Fl%TURE OR ITEM <br /> WF,TER CLOSET A/C–A/HANDLINO UNITS <br /> BATHTUB � FORCED AIR .`iVSTEMS <br /> � LAVATORY (W.4SH BASIN) _ HEAT PUMP <br /> SHOWER UNIT IiEATERS <br /> I � KITCHEN SINK 8 DISPOSAL � CL�71rIES DR'!ER <br /> ,� DISHWASHER RANGE HOOD <br /> LAUNDFY TFAY � WATER NEATER <br /> � CLOTHES WASHEA _ METAL F�REPLACE/STOVE <br /> URINAL _ FIREPLACE iNSERT <br /> DFINKING FOUNTAIN � DAS fIREPLACE <br /> FLOOR DRAIN GAS RANOE <br /> _ BACKFIOW PFEVENTER � GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> I = —I <br /> I HEREBV CERITIFY THAT I HAVE READ ANC EXAMINED THIS APPLICATIGN AND KNOW THE SAME TO BE TRUE ANU CORPECT. AlL <br /> PROVISIONS OF LAWS ANO ORIDINACES GOVEHNING 7M15 TVPE OF WORK WILL BE CUMPLIED WITH WHETMER SPECIFIED HEPEIN OR <br /> NOT. THE GRANTING Of A PERMIT OOES NOT PRESUME TO GIVE AU MORITY TO VIO�ATE OR CANCEL THE PROVISION OF ANV OTMER <br /> STATE OF IOCAL LAW REGUTATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZEO BY THE <br /> O NER Of TNIS PROPERTV TO PERFORM TME WORK FOR WHICH APPUCATION!S MAOE AND I COMPLY WITH THE STATE <br /> � C NTFA`�RS LAW 182�CW AN9 296200 WAC. � <br /> )�i � '' f,''�(,� �� _��g "C�� � <br /> � SigneWreof wner/ oNractor/ ulhonzed gent eta �' <br /> i I <br /> � <br /> 1 <br />