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PKWIT APPLICATITJ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. / PERMIT s <br />L 10 2 i�� K Fit 9AV a CoaD R-oc <br />LEOA LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />Lo/S AVt 9gZa3 (?;S 3a�T <br />1Gngryl ngMt CONTACT NAME <br />p PHONE <br />%5RlAA] Ak�wxi �ZoG 396 6906 <br />CONTRACTOR A /` 2 . Sr4,L� &,J ADDRESS ZIP CONTR. LICENSE M <br />�V LCIA/ g 2 I A/La� a ftVe <br />PHONE Zo 6 7V & 76 CO <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />S r� <br />PERMIT <br />TYPE <br />Combination {R.! Plumbing <br />Demolition u Sign <br />I") Addition <br />WORK Alteration <br />TYPE New <br />HEAT SOURCE <br />Electric <br />r <br />Sprinkler <br />IIL.K.J(( <br />Repair/Maint <br />Gas <br />Oyler <br />CONTRACT PRICE OF WORK <br />J �O <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DEBCnICTInN <br />�gyte,,q- <br />tiee� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR REM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />--i <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/BAR/MOP/ETC.) <br />OTHER _ <br />_ <br />_ <br />_ <br />_ <br />_ <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <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. THEE: GRANTING OF A PERMIT DOES NOT PRESUMf TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE nF, LOCAL LAW REGULATING CgINSTRUCTION Oft THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TOP F RM THE WORK R WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR ORS LAW 16.27 qCW 296.200 WAC. <br />