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i�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 /> �c�aa� - �� <br /> SITE ADDRESS PARCEL TAX I.D.M <br /> a�(o � l��- o -o <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER , ADDRESS ZIP PHONE <br /> _��L..—S Da.cr Cc� <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR /J� / ADDRESS LP CONTR.LICENSEM <br /> v� "�/ _ / <br /> PHONE �(JJ,� — pC2S/�� � ///(f�?�C.-/� ��-Q <br /> _J <br /> PROPOSE�U�NG PERMIT U SP nktealian U PI mhtin9al WORK U RepedMeint. HEATSE�CE <br /> TYPE DBmOlidOn U Stgn TYPE New u Qes <br /> U Other <br /> CONTRACT PRICE OF WORK �OOO CITY OF EVERETT LOCAL SALES TA%GOUE IS 3105 <br /> WORK DESCRIPTION <br /> �i /�,C�.�, �d� - a. <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR fTEM NO. TYPE OF FlXTURE OR ITEM <br /> _ WATERCLOSET _ A/C-A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAI FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/8AR/MOP/ETC.) _ EXHAUST FA�! <br /> _ OTHER _ OTHER <br /> _ - _ �� � °� <br /> i - - � <br /> � 1 HEREBY CERITIFY THA7 I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS'Y?E nF WORK WILL BE COMF'LIED WITH WHETHER SPECIFIED HEREIN ON <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUT!1CRIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMAVCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLIC,ITION IS MADE AND i COMPLY WITH THE STATE <br /> CONTRACTORS iAW 18.27 RCW AND 296200 WAC. <br /> � Signature of OwnedContractodAuthorized Agent ate �� <br />