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- <br /> : . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PEF�!JIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS 61 d,�G � PARCEL TAX I.D.If PER 7 k <br /> \�\ O �ver rerM W �UtB s UJO .00 �//� �9 <br /> LEGAL LOT O. BLOCK TRACT <br /> DE.;C. <br /> OWNER ADDRESS Q,�.QQiu� WeiR4005 PHONE <br /> �laS �1} I}a(, <br /> 6�b Tr �5c.o i��dl Av� IVG. 5i-._ I <br /> TENAN'f NAME ��� CONTACT NAME PHONE <br /> tias �,�-i�a <br /> V E CTpRy G1,ns'fa�n �NV'fdy� Fn�,,,,,x w�ollro�� ic <br /> CONTRACTORAIOfjT�1WA�p GUr1ST. ADDRESS CONTR.LICENSEN <br /> • • �s�o ��D� a�� �� 5+. �� Nov.THcc:�asLn� <br /> PHONE yas ���- i �-a b f�£A''L'r'"! (-On �i¢�JO 5 <br /> PROPOSED USE OF BUILDING Bullding Mechanical � Addition HEAT SOURCE <br /> PERMIT � Combination R Plumbing WORK � lUteration D Eiectric <br /> Gtiois{-o�nr� �.¢M}� TYPE Demolilfon D Sign TYPE New Q4 �as <br /> Sp�lnkle� RepaidMeint. U Olher <br /> CONTRACT PRICE OF WORK ,� � O�O . D CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION T�,r����,,,,} 2r,.provwna,.,,{� �'o Igoa� <br /> PL MBINO MECHANICAL <br /> NO. TVPE OF Fl%TURE OR REM NO. TYPE OF FlXTURE OR REM <br /> � WATER CLOSET _ A/C—AMANDLINO UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> HWASHER RANGE HOOD <br /> LA RY TRAY TER HEATER <br /> CLOT WASHER M FIREPLACFJSTOVE <br /> URINAL FIREP NSERT <br /> DRINKING FOU IN GAS FIREPLA <br /> FLOOR ORAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC. _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILI.BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING 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 /> CONTRACT 27 RCW AND 296200 WAC. <br /> Signature o O�ContraclodAulhorized Agen ate P� ✓ I <br /> �(�3' z <br />