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i <br />i ERMIT APPLICATa JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425 257 8810 -FAX 42 . 5i-8857 <br />by O aLC�U" <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />c03- <br />P MIT 0 ' <br />gob-0 S <br />LZGA LOT NO. <br />DESC. ./,: ✓� <br />BLOCK <br />y/L -�% <br />TRACT _ <br />/(O S .C,� On.SS ('Y <br />OWNER ADDRE55 ZIP PHONE <br />[J25- 252 - pOOs <br />TENANT NAME CONTACT NAME PHONE <br />rnrn GR �,— Coro : C i4iZ(s 6Ks t� 4z52-5z, 0005— <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE I <br />F\gcJ \o o-vja)-16iv. Aoi..ti,uj, fU10gg0D <br />PHONE <br />3c-�� �Sa -3�,a �, ���, L�����I� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical <br />R Combination R Plumbing <br />WORK <br />Addition <br />Alteration <br />HEAT SOURCE <br />n Electric <br />TYPE <br />B Demolition YW�(C Sign <br />TYPE <br />New <br />tFL--J{1 Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK �/ h , D L, <br />I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION --L,,.5-ill P'�� o� SZ�� w1T-H �{ "��lin►T SPACES <br />j�NhNTj: rDCAL. C2E0tT "12e, 5 P110Enttx $AULN6-5 6FWKJ Tftr(z1"I-az 6-w?5' <br />AN 0 mat C or TA%IA EV(Zc550 <br />PLUMBING— MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET A/C _ NHANDLING UNITS <br />_ BATHTUB __ FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) HEAT PUMP <br />SHOWER UNIT HEATERS <br />_ KITCHEN SINK & DISPOSAL CLOTHES DRYER <br />DISHWASHER RANGE HOOD <br />LAUNDRY TRAY WATER HEATER <br />_ <br />_ CLOTHES WASHER METAL FIREPLACEYSTOVE <br />URINAL FIREPLACE INSERT <br />_ DRINKING FOUNTAIN GAS FIREPLACE <br />FLOOR DRAIN GAS RANGE <br />_ <br />BACKFLOW PREVENTER GAS PIPING <br />_ <br />_ SINK (SERVICE/BAR/MOP,'ETC) EXHAUST FAN <br />OTHER_--_ OTHER <br />! HEREBY CERTIFY 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 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 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 1627 RCW AND ; 96.200 WAC. <br />c �c� <br />Signature of Owner1Contracto Authonzed Agent U to <br />f%J <br />