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�ERMIT APPLICATI�IN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810- FAX 425-257-8857 <br /> SITEADDRESS PARCELTAXI.D.A ,�ERM3aVR_� _ / <br /> 600a Ca Z.�•. ���,-o �• <br /> LEGA LOTNO. LOCK TRACT <br /> DESC. <br /> OWNER ADDRESS IIP PHONE <br /> ��A l-.�� Sh�a2 ema c„�.� � �__��__.� �gw� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> 42�79i -�'�9� <br /> CONTRACTOR ADORESS 21P CONTR.LICENSE M ��� <br /> C. �. I�w��"`� \�\� c'Sa��A c�.Na�.z+� oc�s <br /> PHONE �,�� � �M g� <br /> PROPOSED USE OF BUILDING Building ,�.,�{!���echanlcal Additlon HEAT SOURCE �. <br /> PERMIT R CombinaAan U Plumbing WORK B Alteretlon �Electric � <br /> TYPE D Oemolition l� Sign 7YPE D New Gas <br /> D Spdnkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7/05 <br /> WORK OESCRIPTION <br /> � Z,�•Sti\� Gus�ow.¢vS P✓}�S� o�edoxR arr��vt�- 3-e�o�. <br /> 69,00o hT'v <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATERCLOSET(TOILET) � A/C—A/HANDLINGUNITS <br /> BATHTUB ,� FORCED AIR SYSTEMS <br /> LAVATORY(VJASH BASIN) _ HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINI<8 DISPOSAL CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACEINSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARlMOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV 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 AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BV THE <br /> " "NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> �TRACTORS LAW 1B.27 RCW AND 296.200 W.4C. <br /> V <br /> Sign re o neNContreclar/A nze Agent ate <br /> DEBIT 8 CREDIT CAP.DS ARE NOT ACCEPTED <br />