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PERMIT APPLICATIC _J <br />CITY OF EVERETT PERMIT SERVICES <br />?200 CEDAR STREET. EVERETT, "'A 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />LOT NO. I BLOCK <br />TRACT <br />PARCEL TAX I.D. N <br />ILL �GFfQ �425� Z131 15Q6 <br />TENANT NAME CONTACT NAME PHONE <br />I&Q1 UA c A6HA4L Ga,D (310)'04"-7 i 1 f><1 <br />CON; RACTOR ADDRESS ZIP CONTR. LICENSE a <br />' 5-ririp 6a.I51rRLx:rrv1r f-, I¢oa `e•�6tr EaDI l 11 21C� <br />PHONE /' ` _ pp �jL11-I�t Soo <br />l`IC JJ ?7 %d `? x� ! r I D S 71CI (le OQ 0 L31 V%(L' <br />PROPOSED USE OF BUILDING <br />I--1 Building <br />Mechanical <br />Addition <br />I HEAT SOURCE <br />PERMIT jell--#)1",�.ombination <br />Plumbing <br />WOR Alteration <br />Electric <br />TYPE Demolition <br />Sign <br />TYPE New <br />Gas <br />D Sprinkler <br />epairWaint. <br />Other <br />CONTRACT PRICE OF WORK + I -;�a 61 /7 Z— I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />gk,uUOiL tN•irl,vr• L.�'R�( 4 Rtc4(rfrai AZ<ck • �fparNT ENTIeY <>�Irti., IIOD 17�.'H�-�( <br />ft:(-O(Am gZ<<Ak-uc-A- t7-YpL4C Ixv�� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />O. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />HOWER <br />TCHEN SINK 8 DISPOSAL <br />DI WASHER <br />LAU DR`( TRAY <br />CLOT S�WASHER <br />URINAL <br />DRINKING -OU TAIN <br />FLOOR ORA <br />BACKFLOW P V TER <br />SINK (SERVICE R OP/ETC.) <br />OTHER <br />— <br />f <br />C-A/HANDLING UNITS <br />CED AIR SYSTEMS <br />HEA PUMP <br />UNIT TERS <br />CLOTHE RYES <br />RANGE HO <br />WATER IIEA <br />METAL FIREP EISTOVE <br />FIREPLACE INSE <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />2 <br />_ <br />1 <br />_ <br />_ <br />_ <br />I HEREBY CEPITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATICN ANO 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 GR� : ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCA W RE ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI PR RC%iVY T PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO LA 1 . AND 29e.200 WAC. <br />-(6-1 <br />late 1/ <br />z <br />