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. . P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> y —�9 �0 7 <br /> SITE ADDRESS PARCEL TAX I.D.p P�RMIT# <br /> '115 3i����R/ ,j - 7C�/ <br /> LEGA LOTNO. BLOCK TRACT <br /> D�SC. <br /> OWNER ADDRESS ZIP PMONE <br /> TENANTNAME CONiACTPORPERMIT PHONE <br /> S�K'�I d71`fiVE C�t,SC,� ?A1� ��— �3�0 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> Si�NDC�f1�n1 ShF�� 2(Qu;. Mf�'��n.T wvaY S SMm-�� 9�i3d <br /> PHONE <br /> I 2ob 3qo -�3�� 5►�t��EssZq�za <br /> PROPOSED USE OF BUILDING Q Building }� A9echanical AdC�uon HEAT SOURCE <br /> PERMIT �_ ) Combination H Plumbing WORK � Alleralion � Electric <br /> IYPE D Denolition U Sign 7YPE New Gas <br /> U Sprinkler Repaidldaint . Other <br /> CONTRACT PRICE OF WORK /:�CJ u� CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> W <br /> WORKDESCRIPTION HW`` U,P C�Cm�C� .!1 nS(l� �V�, wDU�,I SUPRI.�SS�V� S1S�'��~ <br /> ���r� � <br /> -ro P ru - P �P c-� Kw�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE ON ITEM NO. TYPF OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEW SINK 8 DISPOSAL n CLOTHES DRYER <br /> CISHWASHER � / RANGE HOOD <br /> _ LAUNDRY TRAy I ' �� WATER HEATER <br /> _ CLOTHES WASHER . � � �\'� `'Q _ METAL FIREPLACE/STOVE <br /> URINAL \ a� _ FIREPIACE INSERT <br /> DRINKING FOUNTAIN `� ��}`� ` GAS FIREPLACE <br /> FLOOR DRAM �, � � GAS RANGE <br /> _ BACKFLOW PREVENTER � � _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETCJ � ,�J - C� _ EXHAUST FAN <br /> _ OTHER ( � . V _ OTHER _ <br /> �� ���� _ ��a,n�-DUc-T <br /> — � _ <,�rpfP�-�.cio� <br /> I HEREBY CERITIFY THAT I HAVE REAG AND EXAIJ�INED THIS APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAVJS AND ORIDINACES GOVERNING THIS.TYPE OF 1NORK WILL BE COMPLIED INITH WHETHE-R 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 THE PERFORMANCE OF CONSTRUCTION. THAT I HM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOR�1 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA RS LAl i8. RCW AND 296.200 WAC. <br /> �`� � 3b rv� 0'� <br /> Signature o(OwnerlContractodAuthonzed Agent Date I <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �v � <br /> I <br /> , <br />