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t ERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PE[2MIT a <br />3531 4v,-- 4A <br />0ll7--00 <br />S/D 00� <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />M UL U I-'V <y kel v; n/ 617 5-6,1, I?0 ZA k, 5-�cvt.v S w4- <br />TENANT NAMEi <br />CONTACT FOR PERMIT PHONE <br />Vern/ r-A,4- I <br />S4(ve- PL.nI, 774 $835- <br />CONTRACTOR IS`�11 ,Ve N C ` ADDRESS <br />ZIP CONTR. LICENSE IIIPHONE <br />C Sz 6 5 <br />D &�rrr vca 77 c'" <br />Ly.v,✓w <br />ql5-- 774 <br />PROPOSED USE OF BUILDING <br />I TMPEIT <br />n�Slgnbng al <br />R(�, <br />HEAT SGIaUR�c <br />EK <br />TYPE <br />SCombin <br />prinolleati <br />L] RAll, <br />pair/Maim <br />U Other <br />CONTRACT PRICE OF WORK $ 71 7 92 05' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />1�.5141LL C!) /10te SJry <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />j-LOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />GTHER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT 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 TN PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING 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 />CONTRACTORS LAW 1f.27 RC <br />Slgnalurwdi Owner/Contractor/Authonzed Agent Date <br />DEBIT IlJ <br />& CREDIT CARDS ARE NOT ACCEPTED <br />