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� cRMIT APPLICATI�IN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.k PERMI7• <br /> .�'> >v ��.r�v Po3os-��Z <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS �P PMONE <br /> ���Ili.��ll�� Qt.�ius7 5v�v �i 3 vRic<<2�°l� � c/��l a�-��� <br /> TENANTNAME /a CONTACTNAME PHONE <br /> ���L� L� l�'f/ `--���.-P Y �� ��-� �/�(�l���-G''U ��d/.(.t�il.�/7� <br /> CONTRACTOR ADDRESS r.aP CONTR.UCENBE� <br /> S�,�c� <br /> PHONE <br /> PROPOSED USE OF BUILDING ' I �PEIT h( p m kle�(x ot h�)9n b n9 I � EK v R�epair/MainL I „EAT SO�BnE <br /> � g <br /> 1���� o�.��' <br /> �� <br /> COMTR CT PRICE OF WORK �CRY OF EVERETT LOCAL SALES TAX CODE IS 0106 <br /> WORK DESCRIPTION <br /> PIUMBING MECHANICAL <br /> N0. TYPE OF flXTURE OR REM NO. TYPE OF Flf(TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CIOTHES 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/�TC.) _ EXHAUST FAN <br /> _ OTHER /i r::� ,( r � , ������ — Ol'HER <br /> I HEREBV CERITIFY�HAT 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 TYPE OF WORK WiLL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L4W REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PE(iFORM?HE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 2/9 0 WAC. <br /> �;�'l" C�_,(���r l ��.������,��. � �� � v3 <br /> Signa re of OwnedContractor/Authonzetl A nt Date '/y->'. �1 <br /> � <br />