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1���2MIT APPLICATIO�I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEUAR STREET, EVEREIT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�� <br />SITE ADDRESS � PARCEL TAX I.D. # � P�RMiT # <br />5�.. �.V�+f � 1, `��\ �S`�1.� I <br />LOT NO. BLOCK TRACT <br />DESC. <br />G t����.a. <br />TENANT NAME I CONTAC i FQR PERMIT <br />1��k. Gob¢.a� <br />CONTRACTOR ADDRESS <br />-t5 N;sbct C,a�s�'��.��on� �Lnc. P,o, Rdc No <br />PHONE (SC'�> aS7 `OiOQ iC N� =�rAl dS 1• 03C� <br />� <br />PROPOSED USE OF BUILDING <br />DaaS�'o.v�todCf <br />PHONE <br />(�� 3��-o�Sti <br />ZIP CONTR. LICENSE # <br />GIaR.ko�.�S,OR q�0�5 '��SCi4s4yoN <br />� Building j� Nlechanical <br />PERMIT COmhinati0n B PlUmbing WORI <br />TYPE Demolition Sign 7YPE <br />Sprinkler <br />CONTRACT PRICE OF WORK � ac'{O � CY�Jp � <br />Addition <br />Alteration <br />New <br />Repair/Maint. <br />HEAT 50!1RCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORKDESCRIPTION ���� l�e�v�t �O E�t�S'f�� �I� gM�W�fII. <br />.1 <br />NO. I TYPE OF FIXTURE OR ITEM <br />V��ATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISFOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. .I TYFE OF FIXTURE OR ITEM <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 />EXHAUSTFAN <br />OTHER _ <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 �RANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FORyJ HICH APPLICATION IS MADE AND I COMPLY W ITH THE STAT� <br />CONTRACTORS LAW 18.27 RC1h✓ADfO 296200 WAC. /i / i <br />OY <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />��2 <br />