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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-9857 <br />a _y -03 <br />SITE ADDRESS �% O S—L3 - C7.G7`r %C' <br />//� PARCEL TAX I.D. # <br />PERMIT a <br />jj✓a_,/, <br />(3 Z -cx`y <br />LE AD NO. <br />BLOCK <br />—� <br />TRACT <br />ESC$LOT <br />DESC. <br />OWNER _fir—_7' ADDRESS ZIP PHONE <br />C el m-61e&/1 Gamey 911 1= If 3�' G 2c� / <br />TENANT NAME <br />CONTACT NAME PHONE <br />Gc-i 1��� <br />�rn��s 2-I ss�l� 45�C <br />CONTRACTOR i ADDRESS ZIP CONTR. LICENSE# <br />PHONE <br />PROPOSED USE OF BUILDING <br />,L-,//Building D Mechanical " <br />PERMIT I ) IFU--(( Plumbing <br />WORK <br />Addison <br />R Alteration <br />HEAT SOURCE <br />n EWctric <br />�G/ K'+✓5T(s� <br />Demolition <br />TYPE IIL-�J( Demolition Sign <br />Sprinkler heads) <br />TYPE <br />B Nev, <br />Repair/Maint. <br />IIL-n-J(yGas <br />Other <br />(# of <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE iC 3105 <br />WORK DESCRIPTION 117.-f ,� `` t�C /r �s p�L - LycCt- <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />_ <br />A/C — A/HANDLINGUNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />JRINAL <br />FIREPLACE INSERT <br />_ <br />"RINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />BOOR DRAIN <br />GAS RANGE <br />,KFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER - <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 LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPE TOP FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1 C D 296.200 WAC. <br />Signature of Owne ontraclor/Authorized Agent Date <br />