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` PERMIT APPLICATiOnl <br />4:77- CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425 -257-8810 <br />Sozo3-o/b <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />bob SE f:vezEr MALL hI,4 <br />113 R Sy r-- �-- 010 -DUOq <br />��_ZL3' clll) <br />LEGAL <br />LOT NO. <br />BLOCK <br />TRACT .1 <br />OWNER i ADDRESS <br />PHONE <br />905fWA PROPER'f1t;3 500 S[ EyCut-Ti W1a(.t. (,Jay '�A-1 <br />I yZS. 353.6113 <br />TENANT NAME CONTACT NAME <br />PHONE <br />jZuu►t1n-�4 Pvba,1.1a,1( C01MN— I Al. Ntl.tWsKl <br />yz5, 353,6900_ <br />CONTRACTOR <br />I ADDRESS <br />I CONTR. LICENSE # <br />LuSi'om 7c3ityl $rGJl,�Cj <br />42.3 Kew-1't'uGky s7- <br />I C�STo1�5U4;;�% <br />PHONE. �60 bSc�„ II SO <br />i FjELL/.v6N�tw1 W4 c6ZZ.S <br />I CUS16750 6LSIZ <br />PROPOSED USE OF BUILDING Building � Mechanical Addition HEAT SOURCE <br />PERMIT I Combination Plumbing WORK Alteration D Electric <br />L_--L <br />� � <br />TYPE Demolition Sign TYPE New Gas <br />COnt;ui;-2.[.I n L Sprinkler Repair/MainL Other <br />CONTRACT PRICE OF WORK 3 — I Oa O U ( n OF EVEREIT LOCAL SALES TAX CODE IS 3106 <br />WORK DESCRIPTION <br />il)i=C-/inlsih[-l. NEI.J ELt—Z-rj2iGgL SiG�S <br />(qt_L oLD sfc-,vs A�c Rt�ctcv��) <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />_UNIT <br />HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />IAUNDR`! TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />SIIJK (SE?VICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <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 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 LAIN 18.27 RCW AND 296.200 WAC. <br />��,�,��r�Jz� <br />Signatt a of Owner/Contractor/Authorized Agent Date 1/Z , <br />