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C ERMIT APPLIMCCIN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT # <br />Sbs Se. et/cizoTr nti.r,4, <br />Wy. <br />Z$ U51 B Cx 048 00 <br />S DA a-00f, <br />LEGA �LOTtI�O.Twr b <br />BLOCK <br />TRAC <br />.T <br />DESC16 U t <br />8.01 <br />OWNER ADDRESS ZIP PHONE <br />P6t3151 <br />1445 llvSs /�2rs <br />It �yo� lets i�C 7 <br />TENANT NAME <br />CONTACT NAME PHONE <br />-SUciwA.y <br />I ^AIK&j ?ram -G23-7G7er <br />CONTRACTOR <br />ADDRESS ZIP CONTR. LICENSE# <br />'rW',P*-W ,� <br />3e.144 sIXT4 �✓E. 5. 9a/sy TRxDe9rc/136/"` <br />PHONE 2&"y 23�7G <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />B <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination Plumbing <br />WORK <br />P Alteration <br />Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACT PRICE OF WORK <br />��• e� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/.em s T-3e.C.LL 144 ram,O. - <br />4-J 7T&-Rs oiv MA -&WAy� Sf6q N M Ft:; . <br />my o"fFi�R`S. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />AfC—A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIOINACES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WI1 H WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES <br />NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE FERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />_ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE [ <br />CONTRACTORSLAW 118.27 RCW AND 296.200 <br />WAC. <br />6gnature of OwnerJCon roc r/ ut oozed enl Dale to C <br />onr'i� <br />�a <br />