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ARMIT APPLICATI& <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42�,-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS (L O oqok-005 <br />PARCEL TAX I.D. N <br />PERMIT M <br />7 Yl6 &Ve y [y4n-67 - lob <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />A In j , 6k)/vSTR 4.(c CU rl/ <br />TENANT NAME I <br />CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />,00A31v%)rN A-n-ILi /n c 2_933U <br />PHONE 9kzz /zOB�rv/>>KZ?Z< <br />�a�oJ <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERM.' <br />B Combination ILKJ! <br />WORK Iteration <br />Electric <br />S h- <br />TYPE <br />gmbing <br />Sign <br />TYPE ew <br />Gass <br />p�j�Demolition <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK / b OU <br />?� <br />CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <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/HANDLINGUNITS <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 />CLOT HES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACEISTOVE <br />URINAL <br />FIREPLACE INSERT <br />= <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />i <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I <br />I HEREBY CERITIFY THA 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 CANLEL 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 />CONTRACTORS LAW 1$�RCW AN0296.200 WAC. <br />Y <br />3 ld� Z <br />11 — <br />S rt uro of Owner/ ontractoriAuthonzed Agent —Date r <br />