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&RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT n <br />v �r5 [-�31'vad tt) L <br />V) 0 L <br />LEGA LOT NO. <br />LOT NO. <br />BL CK <br />BLiCKLEGA <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE , <br />_ oIcC' s (O.t3bx76fl <br />TENANT _&I L,1 (��G(7ctn�c <br />CONTACT FOR PERMIT�(i U//1 LIC_W WA PHONE <br />L <br />4saz 7- <br />�N �.v � s ��� � D,m vi� nn <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 8 <br />r' /n <br />YYY <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical <br />Iif--'-(1( Combination Plumbing <br />Addition <br />WORK Alteration <br />HEAT SOURCE <br />Q Electric <br />TYPE <br />L.j Demolition Sign <br />TYPENew <br />Lj Gas <br />Lj Sprinkler <br />R <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION ' <br />l9 upl l �' <br />i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C—A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <br />= <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />J_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />,P, <br />OTHER iilo0 v SiAIe <br />OTHER _ <br />YVLn nnh g,.,1c <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 AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF 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 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 W 18.27 RCW AND 296. 00 WAC. <br />�-1G-0:5 <br />Signature of C e o tractor uthorize Alger Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />