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112&3 <br />PERMIT 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 />G ' 55vr -- 5W. <br />PARCEL TAX I.D. # <br />Mi ))ax) <br />P RMIT # <br />64 yo <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />Wt LbE0- � �� r X 49�1 m► ,I 14_e oyx %Z75 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />L-AiMn 60rP I <br />Ciaju Pentan (34-733-y1,52 _ <br />CONTRACTOR ADDRE S p ZIP CONTR. LICENSE # <br />C.L-ArREj /A& ? I'12 NUtsrcvi Sr C�I� �hvnrOJp emu. (3QAINA9(n3cg <br />PHONE <br />(3W) -733-4W Z <br />PROPOSED USE OF BUILDING <br />Building ■ Mechan <br />AdditJon <br />HEAT SOURCE <br />245 -L�i.�-��al ftW1 <br />PERMIT <br />[j Combination ILH'J� Plumbingical <br />Alteration <br />Electric <br />[Y� tin <br />' <br />�Lr"r" e5 <br />TYPE <br />I <br />Demolition Sign <br />B <br />(WORK <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repatr/Mainl. <br />Other <br />CONTRACT PRICE OF WORK j,& 2'74- bL) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />I_ _ <br />WORK DESCRIPTION In-AiLI1 (I) Z"-TOtV G85 jv41:1l(KI 6jee-Iri(1_ Ocrl>� r-cc F-kp(L!lr'+• <br />PLUMBING <br />MECHANICAL <br />NO, TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSt T (TOILET) <br />A/C - A/HANDLING UNITS <br />_ <br />_ <br />BATHTUB <br />= <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 />URINAL <br />FIREPLACE INSERT <br />_ <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIP114G <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED HIS 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 THc PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OpW��Nt/EEE/ti�R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />ACTORS LAW 18.27 RC/),Yti96.200 WAC. <br />Signature of Owner/Cot ctor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />IM <br />00 <br />