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PERMIT APPLICATION <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. III <br />PERMIT 0 <br />3/" SE EVr-eETT M" tJAY' <br />00•/60 20 130030 <br />1307�/O- e8 <br />LEGAL LOT NO. <br />I BLOCK <br />TRACT <br />DESO 2 <br />OWNER ADDRESS apri ,lam �y,,,,�,�,,,p PHONE <br />9ZIP <br />,E✓tea,m rr /'-/A - <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />V,lt- / Rer,4/c 6V14xi/,✓4 <br />C?,t/(� /�/G[ 2 2S'2-833-/ZY6 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 9 <br />F/q4 ggsrr GvL`Si .2/� Fy& ,7-44C eb A-' r�B <br />F/Rzs"z lilo8ii <br />e,pMS <br />PHONE S3-tYj3' /� yp p.QG/ F/G iA 5060d,17 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />n Building I� Mechanical <br />IIL--J(( Plumbing <br />(WORK <br />Addition <br />R Alteration <br />HEAT SOURCE <br />Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />[u, Nev <br />Gas <br />41F�-Q}{(-Combination <br />Sprinkler <br />RepairlMaint. <br />Other <br />CONTRACT PRICE OF WORK 2 220 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION �tOv/odlKLt�C <br />7'� PirvT<c r TNC /.t/TCIt/ ort o.F ,ti6�✓ �t//[.4/[/!1 . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ <br />A/C - A/HANDLINGUNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WAi ER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />_ <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />F/JQ�r�iFC..�rL <br />_ <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 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 LAW 18�W AND 29fi200 W <br />Signature of O ter/Contractor/Authorized Agent Dale <br />1 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED / y <br />