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PC. :RMIT APPLICATI�` N <br /> CITY aF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> �c oZa� -p�� <br /> SITE ADDRESS PARCEL TAX I.D.A I P IT x <br /> /2/l fi[v' 9 `���''l�7�` Cv fazo <br /> LEGA LOT N0. BLOCK TRAC7 <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �i ! /)/f� ����Z� <br /> TENANT NAME I CONTACT NAME S'el PHONE <br /> /�P�� �'r�a n a y?S 6i1,2-�0�i8" <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> PHONE � �j P Y <br /> PROPOSE�USE OF BUILDING BUilding � MecheniCal Addilion HEAT SOURCE <br /> PERMI7 Combination Plumbing WORK Alleratlon R Eiectric <br /> TYPE Demolilion Sign TYPE New �...j Gas <br /> Sprinkler RapaidMaint. L.) Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTURE OR REM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HE,�T PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br /> PROVISIOiJS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTCRS LAW 18.27 RCW AND 29G200 WAC. <br /> �� �-c ��- �Z <br /> Signature of OwnedContractoUAulhorized Agent Date <br />