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PL.AMIT APPLICATIdJ <br />CITY OF EVERETT PERMIT SER;IICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. • PERMIT # <br />w r? ✓f�� / aLvc ov 93:?0 rro coa07-01� <br />LEGA LOT NO, BLOCK TRACT +^J ,/, <br />DESC. 4 1". 1-7 n-r1n � l r7' 1- 14 1202 3►-GV <br />f-iie,4AJ S 72UtiiP 7904i FEVFRLFk VD gg2o3 -125 34.53(o2- <br />TENANT NAME I CONTACT NAME PHONE <br />)roWl< FP,+NK 7�t)MP 12 5 919 3io z <br />CONTRACTOR ADDRESS 23P CONTR. LICENSE# <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />I <br />BuikJng <br />R Combination <br />B Demolition <br />Spnrkler <br />I"j Mechanical <br />ILHJ( Plumbing <br />Sign <br />WORK <br />TYPE <br />Adaitan <br />p Aneration <br />New <br />RaparR.iara <br />I HEAT SOURCE <br />� Electm <br />Gas <br />Other <br />CONTRACT PRICE OF WORK <br />-q 7 <br />CTTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRNMCN <br />New tus� <br />PLUMBING <br />MECHANICAL. <br />r10. I TYPE OF RXTURE OR REM <br />Emo-1T: PE OF RXP_'RE OR ITEM <br />WATER CLOSET / / <br />BATHTUB l/ <br />LAVATORY (WASH BASIN) ill <br />SHOWER. <br />KITCHEN S NK 6 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINA- <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK I SERVICE, BAWAIOP'ETC ) <br />OTHER <br />A/C - AMANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIFZPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <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 />PROrISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COUPLED WITH WHETHER SPEC :IED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOPATY TO VIOLATE GR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUEATING CONSTRUCTION OR THE PERFORMANCE OF CON-STFXoC..OH THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORM FOR V/F11C14 APPLK:ATCR I, MADE AND I COMPLY WITH TIE STATE <br />CONTRACTORS LAW 10 27 RCW AND 295.200 r"AC <br />Sagnalure of OwnefmCoPtfacIot/AAWIonZed Agent Daft <br />