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I <br />PERMIT APPLICATION <br />00L CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />k Gzjc>'� -L>D <br />SITE ADDRESS F 2-1 <br />PARCEL TAX I.D. # <br />PERMIT M <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CGwA�y w \ �4L- �Dmc 4 Lodn <br />II CONTACT NAME PHONE <br />kio�ty 'A'2-5''A -1 W,99 <br />CONTRACTOR DORESS ZIP CONTR. LICENSE # <br />C'40.3v\ FI�1Yc, `PfC)AAtc-�-\o�►y- VV C''.^ <br />I22 <br />1 ^� �` �C�YZ^0LOWF�pdp�OyL <br />PHONE 11Q_S.��1'� toW_l Ll „I 'L W• kv)�/000a _ `. Xv `J✓1 kf\r 19012 <br />PROPOSED USE OF BUI DING <br />�� <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />WORK <br />Addition <br />fKb�71F Alteration <br />NEAT SOURCE <br />R Electric <br />COrnm�YG, <br />TYPE Demolition D Sign <br />TYPE <br />b New <br />u Gas <br />Sprinkler <br />Repair/Maint. <br />LJ Other <br />CONTRACT PRICE OF WORK I t �j�, — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />�'A 2 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />— <br />A/C-A/HANDLING UNITS <br />BATHTUB <br />— <br />FORCED AIR SYSTEMS <br />— <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />— <br />SHOWER <br />UNIT HEATERS <br />— <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />— <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERTGAS <br />DRINKING FOUNTAIN <br />FIREPLACE <br />FLOOR DRAIN <br />RANGE <br />_ <br />BACKFL0IV PREVENTER <br />—GAS <br />GAS PIPING <br />— <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />I <br />OTHER <br />OTHER <br />HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />jI <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 <br />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 />CO nTCTORS 18.27 RCW AND 296.2G0 WAC. <br />SLAW <br />S0jdture 01 wner/conlractor ut oozed Agent Date <br />