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� cRMIT APPLICAT��1N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FNX 425-257-8857 <br /> SITE AD�RESS PARCEL TAX I.D.k PERMIT n <br /> �S� �°�`U�"� GD - 3 S 2 - 36 _02_ 30 0 0303-D33 <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. � 3 6 y �/�i'p" O/vI�1�o�V /✓ PCAT' ,�� <br /> OWNER ADDRE55 Z1P PHONE 3 -S07j I/ <br /> ,u�-� ,v�ub�-�/ ���3�3- 8� <br /> TENANT NAME I C�ACTt�/fF /'V�GU�tN C�cA9>! / O���!-� <br /> S'l�7ZC�' /1'S Ou�ii/�iC <br /> CONTRACTOR � �� ADDRESS ZIP CONTR.UCENSEN <br /> PHONE �zs3�a�i_ G�68. �°�"°�° ��� &��. . ��33g / v7�.S$���,�' <br /> D � <br /> PROPOSED USE OF BUILDING Building MeCheniCel Addlllon HEAT SOURCE <br /> PERMIT � Combination R Plumbing WORK R Alteration � Electric <br /> TYPE Demolition ��� Sign TYPE D New Ges <br /> Sp�inkler(N ol heads) U RepaidMaint. Other <br /> CONTRACT PRICE OF WORK �8p� ✓'� �-CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> <�✓�T4CG /�'� �}2dN/N�F <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> IAVATOflY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> UR�NAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRA�N GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINGD THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AN�ORIDINACES GOVEflNING THIS TYPE OF WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM 4UTHORIZED 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 78. 7 R .AND 296.200 WAC. <br /> �11���u �/7�03 <br /> Signature of OwneUContractodAut onze gent Date � <br /> ��2i <br />