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�,ERMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 7 <br />425-257-8810 — FAX 425-257-8857 <br />FOao(-0 - 00f <br />SITE ADDRESS <br />Z0)If 5 FEQ AviF <br />PARCEL TAX I.D. A <br />DO Cj37/ &77 00ooOO <br />ERMIT M <br />6a07-005' <br />L- <br />LEGA t r)T NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />AVEes►✓L� 2 S `E Ek/4c A✓f 4'70I <br />TENANT NAME <br />I CONTACT NAME _PHONE <br />a B/L c- - <br />rHqvS <br />STvAR'T worrtr 2 -3y 5 -'S637 <br />CONTRACTOR ADDRESS <br />()OrA'0ilk42lAL- r�Ra�c�Ty �offMECC�p2L 1 <br />PHONE N^ P /N T . <br />w5- 70-5 -z6// wFT.-^oxE A✓c FVi v2zol <br />PROPOSED USE OF BUILDING <br />R�e x . <br />Building Mechanical <br />PERMIT ,RRy Combination I.R.( Plumbing <br />TYPE Lj Demolition LJ Sign <br />WORK <br />TYPE <br />Addition <br />Alteration <br />New <br />HEAT SOURCE <br />I��-sectric <br />R/ Gas <br />W P <br />U Sprinkler <br />Repair/Maint. <br />U Other <br />CONTRACT PRICE OF WC'R. ?0? <br />CITY OF EVERETT LOCAL SALES TAX CODE IS atos <br />G <br />WORK DESCRIPTION <br />Fill E PA •K r, 6- € l2 EPA /IA S , <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR REM <br />L <br />WATER CLOSET <br />A/C - AIHANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS . <br />L <br />LAVATORY (WASH BASIN) <br />HEAT PUMP ; <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />UNIT HEATERS <br />CLOTHES DRYER <br />DISHWASHER, <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />__ <br />METAL FIREPLACEISTOVE <br />URINAL <br />FIREPLACE INSERT <br />— <br />_ <br />DRINKING FOUNTAIN <br />�_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />GAS RANGE <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />�_ <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />i HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND C07RECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED -IEREIN 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 TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 8 W AND 296.200 WAC. <br />- L oZ <br />Signature of Owner/Contractor/Authorized Agent Date <br />tlZ <br />