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� �RMIT APPLICATI�iN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE A�DRESS PARCEL TAX I.D.N � RMIT M <br /> �001 041�� h+�+�vs, aQ°I"'�9 6 �I 4eo 1 o�s - <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> sNo���?- GBvvr�li'Y �,aczs r�Li���� ffv�►Jv►� �r m�) <br /> TENANT NAME CONTACT NAME PHONE <br /> s�ro+�,��t4 ���� r 7� ��B�S�'�-'E 42�— 33a- 3,ryb <br /> Y�r ' c l�av <br /> CQ_NTR�Ofl��C' I , �— ADDRESS ZIP COMR.LICENSE N <br /> IVb �^� nnRm oR� 14oN� <br /> PHONE <br /> PROPOSED USE OF BUILDING Building f7 MecheniCal dition HEAT SOURCE <br /> �_� PERMIT Combinalion K Plumbing WORK Alteration R Electric <br /> �,�, �yfl��Cl,�. TYPE Oerholition �� Sign TYpE New �j Gas <br /> Sprinkler Rapair/Maint. U Other <br /> CONTRACT PRICE OF WORK � /J!/� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � ��/ <br /> WORK DESCRIPTION <br /> �f�r��o-p- rn�P�Y^��`t 1t o�s fio p�t?��.Be-m 5 �, i�1�Tq�wi�-��rn•l <br /> o�_ �C r.,c- sr�,���..v� �<���r?�w. N� wrm� �r Rw�o�,�o- �`^"'r,� <br /> �iJ'v1^O�r7 l'1.hrr�'�� c��l"r'�''6 �'�L�"'i5 �O' (�^�!'1� �'t`('- 1 , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF fl%TURE OR ITEM <br /> _ WATER CLOSET _ A/C–A/HANDLING UNITS <br /> i BATHTUB _ FORCED AIR SYSTEMS <br /> j _ LAVATORY(Wr�SH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAI _ CLOTHES DRYER <br /> � _ DISHWASHER _ RANGE HOOD <br /> i 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/8AR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CEtiITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> PROVISIONS C`�-J�WS AN�ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIE�WITH WHETHER SPECIFIED HEPEIN OR <br /> NOT. THE GRP' TING OF A PERMIT DOF,S NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCA�LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PAOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1 7 RCW AND 296.200 WAC. <br /> �i�J'1^,� ^-e�� � 13 � f ff� ' <br /> Signature of Owner/ContractodAuthorized Agent Dale � <br /> �/� <br />