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) <br />�r PERMIT APPLICATION <br />�n CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. WA 98201 <br />425.257.8810 — FAX 425-257-8857 <br />SITE ADDRESS I PARCEL TAX I.D. t PERMIT . <br />j//n 1 ,, r r, � i i A6A11 1. �11. / M 03D4-OD9 <br />LOT NO. I BLOCK <br />ff`71zv_-' <br />TENANT NAME —---------i I CONTACT NAME ' PHONE / <br />1 B•f-L 11)N'-T tU ULs - 2s 1y3 y <br />CONTRACTOR Gv �T 5H��rjL ADDRESS 3510 G Fc% r ZIP CONTR. LICENSE ~ <br />f iS2r� EtIFRFJ>>/GID� <br />PHONE j42S 7,�%),%q3V <br />PROPOSED USE OF BUILDING <br />L <br />PERMIT <br />TYPE <br />I <br />H Budding <br />Combination <br />Demolition <br />Sprnkler <br />Mechanical <br />Plumbing <br />pSign <br />WORK <br />TYPE <br />Addition <br />Alteration <br />New <br />RepairiMamt <br />HEAT SOURCE <br />Electric <br />as <br />Omer <br />CONTRACT PRICE OF WORK 12, W <br />CITY OF EVERETT LOCAL SALES TAX IS 3105 <br />WORK DESCRIPTION /�.+��� <br />Q� <br />�'v! 1-0 /1 <br />CIAI 17 GC!, i N4-1C1- <br />/�%.v V <br />tC-ODE <br />-1 N 1 /;o L <br />I <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <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 (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />A/C - A/HANDLING UNIT rtl c'<' <br />FORCED AIR SYSTEM. <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN --dpST.. 6 <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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. 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 />COI RACTORS LAW 18 27 RJR ND 290.200 WAC. <br />i l t6L' <br />Signaturd of net/ontrat: or/Auth r ed Agent Date I/a <br />