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PEHMIT APPLICATION <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 />��� S,C✓, /=VCrG�l'r <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />Slr� -q�,� i yo Zz <br />TENANTNAME <br />PARCEL TAX I.D. # <br />h9A[L w�y Zyzgoy /- �L7-eoo3 <br />BLOCK TRACT <br />CONTACTNAME <br />PERMIT k <br />S�i � l-ou <br />r� 58i33-La6-s�6-�/i5s- <br />PHONE <br />�A�t� FArin � � 5-�tuL /�Lo.�� �fZS- 77s�` g�3S� <br />CONTRACTOR ���� y�dN G o ADDRESS ZIP CONTR. LICENSE N <br />a s= ��6- S� 3.s- �o. a� S--z6 y ��NNL✓4TiO ,��„y ��: <br />PHONE 7 N�o % 't <br />4.A s'8 YL <br />PROPOSED USE OF BUILDING <br />/NS c��4� <br />CONTRACT PRICE OF WORK �j'S <br />WORk DESCHIPTION �NS��kLL <br />%�} CL �-� <br />r <br />PLUMBIN( <br />NO. I TYPE OF FIXTURE OR REM <br />Building Mechanical <br />PEpMIT B Combination R Plumbing <br />TYPE D Demolition ,�Sign <br />u Sprinkler <br />Y9o. '" <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Addition <br />Alteralion <br />eW <br />RepaidMflinl. <br />HEATSOURCE <br />D Electric <br />B Gas <br />Other <br />CITY OF EVEREIT IOCAL SALES TAX COOE IS 3105 <br />(/) .S�-� o� �4•v G�i4�iyiL L��%S <br />NO. I TYPE OF FIXTURE OR ITEM <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 />FIFEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />Oh <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 A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL V+W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPE TO PERFO M THE WORK F H APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW . 7 RCW 6. <br />/Z-�-�( <br />Sign ure ner/Conl uthorized Agent Date �� <br />v <br />