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PERMIT APPLICATION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf. WA 98201 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42S2G]-8810 —FAX 425-25]�8&5l <br />425-257-8810 -FAX 425-257-8857 <br />SITE POg1E88 <br />SITE ADDRESS <br />�f5Zb J�RAL slY�Nl7E <br />ysz,,rFu�ua�avcwus <br />PARCEL TAX <br />p PARCE�Lr TAX I.D. k <br />*siaees-z•oiz-0007 <br />P(.AMRY <br />PERM/I�T� rt jy� <br />V lJll� <br />6��� <br />IEGP LOT NO. <br />LEGA LOTNO. <br />oast. 1—y <br />BLOCK TMC� <br />BLOCK TRACT <br />A_� `, d <br />MOGINAI AsiseaFEClwl B�'6v/rNIP lry�MMiPNC$NIP <br />�p ADDRESS DP WMO E <br />OWNER REDRESS ZIP PHONE <br />C�F1P.{4S lkAgN y52L PeDEBAc. rVeNt� 48.�18 <br />CCMIP>�S �c� f�SRAC. fi1lLNuE , �• 48�8 <br />TENANT NAME <br />T,EH uM•N'<'M6I�-rI <br />I'r-,�,,I <br />�ol�s r <br />!� flf�^ <br />CONTACT NAME PHONE <br />�p�ON�I �W�W\ �1/���Y�a� �S�l�LOII <br />� �t lo�srarri - G�rrc�z ffil�Jc�s� yzss, ssrp. �'tq <br />CONTRACTOR ADDRESS COMR.IICENBEI <br />Taae R�e�e [�ee�rnorJ l9s�l�r+�WY Nat ItD, Mi:t�d ZIP 'TL�vrAM��gN3 <br />?cwrx To Cron! 1� AC�uit1Y Nhc. �, Art'. H�Not� cD- t��S <br />PHONE �.��,.y�/ <br />vxoxe � �, �/ <br />vnowazo use OF BUILDING <br />PROPOSED USE OF BUILDING <br />u�D <br />Ll�ENSED <br />PERMIT <br />PERMIT <br />aiti�q nuxne�KY <br />� Building � Mechanical <br />� COmEln�liWl D mumeuq <br />Combination Plumbing <br />namo� <br />Addition <br />xromc � n�.a� <br />WORK � Alteration <br />HEATSOURCE <br />HEAT SOURCE <br />� Electric <br />� e.n� <br />TYPE <br />TYPE <br />�eT0lilb� U Sign <br />Demolition Siyn <br />TYPE Ww <br />TYPE New <br />Gas <br />Gas <br />SOMMk� <br />Sprinkler <br />A+P'��IAYnI. <br />Repair/Maint. <br />ON,v <br />Othor <br />wnrnacrmceoswonK �/A�� <br />CONTRACT PRICE OF WORK L��f � <br />cmarerenttr �ou�aaesr�cau�a o�ae <br />CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 — <br />— <br />WORK DESCRIPTION <br />"�°m�rere�rr au e�ag s.aoo.sF: rn� Y d ii� aeE Foud��j ,x <br />Tbt� 1M�pte��er1T ON EXt91N! 3,dADf � 7YP� Y � L/t>ant� b+�� Rui liuEj oil <br />PanprsHaent fib. <br />PLUMBING <br />PLUMBING <br />MECHANICAL <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR rtEH <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. T'PEOF Fl[IVREOMIIEM <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />WATER CLOSET <br />NC-MNNOLING UNITS <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />BATHTUB <br />FORCED AIR SYSTEMS <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WISH BASINS <br />LAVATORY (WASH BASIN) <br />_HEAT <br />—HEAT <br />PUMP <br />PUMP <br />_ <br />SHOWER <br />SHOWER <br />—UNIT <br />UNIT HEATERS <br />HEATERS <br />_ <br />KITCHEN 51NN8 DISPOSAL <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />CLOTHES GRYER <br />_ <br />DISHWASHER <br />DISHWASHER <br />—RANGE <br />HOOD <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />LAUNDRY TRAY <br />—WATER <br />WATER HEATER <br />HEATER <br />_ <br />CLOTHES WASHER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />URINAL <br />FIREPLACE INSERT <br />FIREPLACE INSERT <br />_ <br />_ <br />DRINKING FOUNTAIN <br />DRINKING FOUNTAIN <br />—GAS <br />FIREPLACE <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />FLOOR GRAIN <br />GAS RANGE <br />GASRANGE <br />_ <br />BNCHFLOW PflEVEMEB <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />GAS PIPING <br />_ <br />SINK (SEB�ILbBAfU1dAWEiC.� <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />OTHER <br />OTHER <br />— <br />I HEREBY LEHIiIFV iNAi I HAVE FFAIIFN� EXAMINED THIS APPLICATION AND KNOW THE SAME TOBEiflVE.W000�iXECT. ALL <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 AN00PIDINPCESGWEflNING THIS TYPE OF WORN WILLBECOMPtIEO WITH WHETHER SPECIFIED HEREIN 011 <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED OR <br />NOi. THE GRANTING OFAPENMR DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE 0fl CANCEL THE PROVISION OF ANY 0iXEN <br />NOT. THE GRANTING OF A PERMIT GOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE ONLCCFLtAW IiEGV1ATIN000H$tflllCiIONGR THE PERFORMANCE OF CONSTRUCTION. iIUiIPMN1iXOPV£O BY THE <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF iH F EXN iO PERFORM THE WORK FOR WHICH APPLICATION 15 MADE PNDIGCNPLV WIiNMESiFTE <br />OWNER OF TH P ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COMMC IBE]flCW RNO3M.RW WFC. <br />CONTRAC 16.27 RCW ANDy298.200 WAC. <br />i <br />s,gnTSl nc maaonaumon..a Agent <br />Signa ur of Owner/Contractor/Authorized Agent Date I/ <br />i <br />\_J <br />