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PERMIT APPLICAT` ON <br />CITY OF EVERETT PERMIT SERVICES <br />XOC2 o-00 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />7 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT M <br />�E FQ" t-: R r-TT HHj.L 1 1 <br />GA LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS LP PHONE <br />,Tr-6 /`'! tn/rc-Tr:,tice-y a n c <br />TENANT NAME <br />_ <br />CONTACT NAME PHONE <br />SL!l i i I <br />1) N bk F (2o6) 66c? 76 <br />COS, ACTOR - ADDKSS `i �p�. LICENSE III1��`l'� . <br />PHONE <br />--lo 'Z-7 --3 < <br />PROPOSED USC OF BUILDING <br />'� 1 k-f— <br />PERMIT <br />Building Mechanical <br />Combination JIbC'�f�,Plumbing <br />WORK <br />Additior� <br />Alteration <br />MEAT SOURCE <br />Electric <br />TYPE <br />Demolition U Sign <br />TYPE <br />�Q Nev <br />Gas <br />C <br />Sprinkler <br />/L_) <br />Repair/Mainz <br />LJ O!ner <br />CONTRACT PRICE OF WORK /�i ,n '-, li7T/ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />'rj ��'v �r r� ze--Illf� <br />IfA/,/ r�� <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_ <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />— <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />Z <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERTGAS <br />DRINKING FOUNTAIN <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />SINK <br />— <br />GAS PIPING <br />(SERVICEfB!,M R OP�ETC.) <br />OTHER �i'O i> ci.� <br />EXHAUST FAN <br />_ <br />OTHER <br />I <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />iPROVISIONS <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 LAW 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />