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"PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />J200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS I PARCEL TAX I.D. p P-RMIT u <br />1• / <br />59c20 CYe 300 I O(z)'&9y5 (00%00 A?/ <br />r ern, ,S,,,4t —I% <br />LEGAy LOT Nd. BLOCK <br />TRACT <br />DESCi <br />OWNER ADDRESS 4 &,3ZIP PHONE <br />C(C.AL �v-nr«„ 0y4y v jp'(ol ��e,e�{�t)A 05.353-440 <br />4 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Ja.v 91,1 6/eve. edfrce� <br />CON RACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />iv.12. lla�spo 1rc Io26tO -/30-'Zc,,e V4-G- G8034' <br />d tL <br />PHONE/' UpZ I" �j%Z� lull/� H19/Y+*1112 /I3 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical <br />Combination fvH( Plumbing <br />DAddition <br />WORK Alteration <br />HEAT SOURCE <br />Electric <br />�/ F� r <br />enT4� Dce <br />TYPE <br />L.j Demolition Sign <br />TYPE New <br />�f Gas <br />u Sprinkler <br />RepairlMaint. <br />LJ Other <br />CONTRACT PRICE OF WORK /�z,s/IUD CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WOR^^KDESC[[RIPTION %v.n t/Gc4 I-/" SPGCe_ 1;140 Af`J I)F,f%cd S✓Ift_ 04" con5ls4S <br />pT- i ope—,-fve',a /'t 54a� -, 54[/,/12, 4,on/ /4 �6 , pet✓k4c cA/.Ze rj'fN TI /O �.(Iq e/ <br />CoA5v/4%4,v., 1 anti wa',4,�� <br />PLUMBING <br />MECHANICAL <br />NO. j TYPE OF F,X L;RE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />u_ <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <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 />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EAAMINED 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 TIIE 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 />CONTACTORS LAWj6.27/jRRCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authonzed Agent Date I�L <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />