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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 <br /> SITE ADDRESS PARCEL TAX I.D.R P RMIT.� <br /> (p419 �1���{- G�A Oo3qz9Qllei� QO �jUS�/� o�� � <br /> LEGA LOT NO. BLOCK TRACT�J <br /> DESC. � y O ( I BeUQr� �1II5 D(�� 2.� � <br /> OWNER n ADDRESS ZIP PliONE <br /> S+olh 0'��c:,hGr-�SB�• (pNl�l Cl�(J�' (�ciy �Ul�e� 9f�?l13 N1�z34,-�YNO <br /> TENANT NAME I ryOaNTACT NAt�}�'pe%� PNONE � <br /> � `u yZs z39-� �ad <br /> (�«t r3acl� <br /> CONTRACTOR 'Z�DDAESS LP CONTR.LICENSE• <br /> Qu-� 13u�Jz Cusf�,� f3���ldr�is , <br /> PMONE t'25� L�9� �S`lD Z(o2� �o�hy, s� � �IIS 9$.2.03 Dt.t'J'13l�CI399SCz � <br /> i <br /> PROPOSED USE OF BUILDING Building fl Mechanical Addition HEAT SOURCE � <br /> PERMIT Combination F_� Plumbing WORK Alteretioa R Electric � <br /> �Q ra y� n'PE Demolilion IJ Sign TYPE New �'� Lj Ges <br /> Sprinkler(q ot heetls) Repeir/Maint. U qher <br /> CONTRACT PRICE OF WORK 70D4� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ,Oa(e b��rlcQrny . �. <br /> v'e•nu✓�- so�� Sc-;- �oles in Cemc.s�� buif <br /> Z(� xz4 �ura4Q � /'o�tr s /ab. <br /> PLUMBING MECHANICAL' / <br /> NO. TYPE OF FIXTURE OR ITEM NQ NO. TYPE OF FlXTURE OR fTEM /!/O <br /> WATER CLOSET(TOILET) A/C—AMANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARlMOP�'ETCJ _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS.�PPLICATION 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 SPECIFIcD 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 AUTHORIZEO BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW iB.27 RCW AND 296200 WAC. <br /> ��7i,�i J7�.c���� I- .zz-o3 J r�`i <br /> Signature of O dCoNractor/Authonzed Agent Date �i/ <br /> ��V I/O.1 <br />