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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 ry ` g -O <br />SITE ADDRESS-ik— <br />PARCEL TAX I.D. It <br />PERMIT" <br />I <br />I;oL-I.-coZ_ <br />LEGAL LOT NO. BLOCk <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP Pr:ONE <br />LC Ix �:&' 3s3 <br />TENANT NAME ^ CONTACT FOR PERMIT PHONE <br />luc1�;G/�ort�westJW+Dcm C�-ri►-t�r P/O-Z 1?6q 6o�2 <br />CONT�jCTOR ADDRESS Z!F CONTR. LICENSE# <br />i �avr1/S l�c�t. �ov.S� I �(36C- �6t=� elk, ��i, `1�a0�/ PNf�MS�C973B3 <br />PHONE •,2 0 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building ❑❑ Mechanical <br />Combination Ly'F'lumbing <br />WORK�teration <br />Addition <br />HEAT SOURCE <br />Q Electric <br />TYPE <br />Demolition ��jj Sign <br />TYPE <br />Jew <br />Lj Gas <br />Sprinkler <br />Repair/Mains. <br />(� Other <br />CONTRACT PRICE OF WORK ��r% 00 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/llEyr SI ) S For megr <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />SHOWER <br />— <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />—L <br />CLOTHES WASHER <br />FIREPLACE INSERT <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR!MOP/ETC.) <br />_ <br />EXHAUST FAN <br />OTHER <br />OTHER _ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME I O 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 PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT S LAW AND 296.200 WAC. <br />/18...22//�]JRCVS <br />Signature o Owner/Conti r/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCtPTED <br />