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'rJERMIT APPLICAI ON <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 />PARCEL TAX I.D. # <br />PERMIT u <br />LEGAL LOT NO. <br />BLOCK TRACT <br />DESC. <br />1— <br />/ONER/' ADDRESS ZIP PHONE <br />L kta eQH <br />TENANTNAMECONTACT <br />FOR PERMIT/ PHONE <br />`/ <br />AI/i(-;G�'/ <br />5'-2/y-S- 8i8� <br />�Gt ('��/ <br />TMOGI <br />7eK <br />CONTRACTOR ADDRESS #- ZIP CONTR. LICENSER <br />D& ✓ �n /3062 SIC/77�ti�L �3 <br />jerc/�lon 7 / /K/ <br />PHONE C-J7 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building rDt�echanical <br />NCombination IIL--,c(' Plumbing <br />WORK <br />Addition <br />Alteration <br />HEAT SOURCE <br />Q Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />env <br />LJ Gas <br />sprinkler <br />Repair/Maint. <br />U Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION T.l l� G1 X /� c,J..t Ile !,^ Cao/c r/ ruv\ �P its fyn f L.:L.e <br />7� eomAre-�sar •5.Pf 5A oao� . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLINGUNITS <br />_ <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAA G� <br />OTHER <br />_ <br />OTHER / <br />_ <br />�tf <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 C STR UCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERWO PER HE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA 10 LAW 15 CW AN 9 00 WAC. <br />Sig r ner/ nt actor/Aut orized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />