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P�RMIT APF�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FIvC 425-257-8857 <br />SITE ADDRESS <br />�� W �1� <br />LE(3A LOT N0. BLOCK <br />DESC. <br />OWNER <br />A4-el1T �• <br />C�ksr a.<A 4 cCT�-t�r lc't�J�crl <br />TENANTNAME <br />PARCEL TAl( I.D. M <br />TRACT <br />ib�o .Yk-t'wu�l.t c�tr+tTi'� 't j-i� � <br />CONTACTFORPERMIT <br />-00 <br />Nti ?35 - <br />PHONE <br />M�T0.lo SK-q r��vr�rJ � J��f- ����raa ►�zr 346•s�3i� <br />CONTRACTOR ADDRE39 ZIP CONTR. LICENSE M <br />J� R��-�caa CANSiYtLLCTIJ� 3i2.f ���t3y ,.�}--�t �1 Lr GY� 1 J�,���CIW4K'i <br />PHONE �Z; �4 b 5 3 �� <br />PROPOSED USE OF BUILDIN6 <br />(� Building Mechenical <br />PERMIT D Combinallon � Plumbing <br />TYPE D Dema!itlnn Sign <br />U Sprinkler <br />CONTRACT PRICE OF WORK (� �, �� <br />WORK DESCRIPTION � <br />��n�e..�..�r P�.rd-ioA w/���5 <br />f1--i_ Ql.✓_✓..r3 �N4 � (�J��� �t! <br />NO. I TYFE OF FIXTURE OR ITEM <br />WATER CLC' :ET (TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCFEN SINK 8 DISPOSAL <br />DIiHVJASHER <br />LAUNDRYTRAY <br />CLOTI�ES WASHER <br />URINAL <br />DRINHING FOUNTAIN <br />FLOOf2 DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />�AddlUon HEAT SOURCE <br />Alteratlon D Eleciric <br />New �� Gas <br />RapairlMaint. U Olhar <br />CITY OF EVERETT LOCAL 9ALE3 TAX CODE IS �105 <br />�i�Q km G'?^`�i , u++wJ ��002 <br />Tuao Siv�cf �'SY o,.�+�tti) <br />N0. I TYPE OF FI%1URE OR ITEM <br />A/C — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIS HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO 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 AUTHORITV TO VIOLATE OR CANCEL TME PROVISION UF ANV GTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OP CONSTRUCTION. THAT I AM AL'THORIZED BV THE <br />OWNER OF T-IIS PROPERTV TO PERFORM THE WORK FOft WHICH APPLICATION IS MAOE AND I I:OMPLY WITH 7HE STATE <br />CONTRACTORS I.AW 1�ZiRCtiM�AND �6�1I0 WAC. <br />_ __. . _ _ _ ___ _ _ 1CCEPTED <br />