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PEA IMIT APPLICATIC, <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />? OZG $ -D / ( <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT a <br />3S 5r= F✓r 1r(7 HAc - t.)P, *'Lt 12 4505 (SM 4 300 <br />LEGA LOT NO. BLOCK TRACT <br />TENANT NAME I CONTACT NAME <br />PHONE <br />�z CoLYLJ I PsNrow, tt C� <br />CONTRACTOR ADDRESS_ ZIP CONTR. LICENSE N <br />1 .(. x.� FL <br />KAk.L- u"Glej0- 23Z.1 <br />PHONE I-1k(Q-1A0P09 'Z L-7 <br />`Lo(o•�t72. 2(,0l S�F`r WA. 181C)z <br />PROPOSED USE OF BUILDING Building f"1 Mechanical FNew <br />dition NEAT SOURCE <br />%�gZ�CrPcf� OF{Ott PERMIT R Combination ILKJx�lumbing WORKera Von I I� Electric <br />TYPE B Demolition Sign TYPE IIV'(1 Gas <br />Sprinkler pair/Maint. Other <br />CONTRACT PRICE OF WORK Lr S pL,;. I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />1 <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & 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 />_ <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 />I <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 />CONTRACTORS I.,AW 18.27ZZCW AND 296.200 WAC. <br />2 �" I <br />$/(5/0 <br />