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ERMIT APPLICATC JN <br />4L CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />'ll0 <br />SITE ADDRESS <br />W, MLLk:itfeo 131vd <br />PARCEL TAX I.D. N <br />PERMIT e <br />00389800000100 <br />�- <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. rj ge P1 <br />OWNER ADDRESS ZIP PHONE <br />Ve-r 12on *1800 41 S+ 5+ Eyere'tfi I WA 9820G 42S 261 - s4o� <br />T�EppANT NAME <br />CONTACT NAME PHONE <br />Xv=lzov) M u ki Relo <br />CONTRACTOR ADDRESS ZIP CONTR.LICENSEM <br />J"ohaAl sev� Mechan(cn I 2a(09 144+k pve NE TO NA" 1-73 PK <br />PHONE^ ZS 48i1 22(o(o VAbodih UI He) WA 9 FO7Z. <br />PROPOSED USE OF BUILDING Building � Mechanical Additicn HEAT SOURCE <br />PERMITP t,ombinalion FjL—�J( Plumbing WORK Alteration RR Electric <br />ComMtv)IcQj10N� TYPE Demolition Sign TYPE New L� Gas <br />B <br />6 <br />Sprinkler Repair/Maint. Other <br />CONTRACT PRICE OF WORK 9-1 0001 <br />CITY OF EVERET7 LOCAL SALES TAX CODE IS 9105 <br />WORK DESCRIPTION �hS+a1I h.ZW vYl eta"', c0.1 Work per Flo-+, M2, <br />l <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <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 TYPE 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 />'FACTORS <br />c(\ LAW 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date ^ <br />