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( <br />[I <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-?57-8857 <br />SITE ADDRESS <br />LEGAL� L` N�� I BLCCK <br />DESC. „> <br />PARCEL TAX I.D. # <br />`N�UI�fOr'1 � <br />�ohn r�Raat�,�.� - st�a ��,4.,e s S.e�,� , Ws�. 9810y s�-i�► <br />TENANTNAMF. CONTACTNAME PHONE <br />�[1 e C� � n.�. n I �i� w, �` OQI.e..,n �LD�O� �7 � ��2$ _ <br />CONTR/.CTOR <br />PHONE �lQ <br />J�IO�L:I'(�VVu3�l-ADDRESS7'L'7 3,�IliT�`,�} <br />l�2'� -3lCxti <br />PflOPOSED USE CF BUILDING <br />! \v�`�"�` <br />PERMIT B <br />TYPE U <br />CONTRACT PRICE OF WORF� tU � CjCO <br />9`C1ONTR. LICENSE # <br />W <br />•. <br />Building n Mechanical Additlon HEAT SOURCE <br />Combination �'"} P�umbing WORK Alteralion [� Electric <br />Demolition ��Sign TYPE New (, Gas <br />Spfinklef RepalrlMaint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORKDESCRIPTION/Q�c�p,.(�¢ 2�f;�g�i�Ag �j►�, s��_ ma..,�+��� ��-r1Sf" <br />on-e 91r- exk�enally i.�lum�nv�d we.cd n�� {- Re�u�.c- (2i non -i <br />Wa�-( s��s_ <br />NO. I n'PE OF FIXTURE OR ITEM <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 />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS kANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTI1Ei2 <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINcD THIS APPLICATION AND KNOW THE SAME TO BE TRUE AhD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THiS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPFCIFIED HEREIN OR <br />NOT. THE GRPNTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITYTO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />Sl'ATE OR LOC.\L LAW REGULATING CONSTRUCTION OR TH[ PERFORMANCE OF CONSTRUCTION. THAT I AM ?,UTHORIZED BY THE <br />OIVNER OF THIS PROPERTY TO PERFORM THE NiORK FOR WHICH APPLICATION IS MAOE AND 1�r_y`p L W^ITH THE STATE ^ <br />CONTRAGTORS LA 18. 7 CW AND 296200 WAC. � -�� '�j f�j IC � O� i, + r, ` <br />'� ' r { v LS �� <br />nat' ue of Own dC t ctor/Au horized Agent Date LJ L� <br />'i;?? O 1 200•4 <br />ITY OF EVER�TT `/ <br />Planning Dept. <br />