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PERMIT APPLICATION <br />APPLICATIONCITY <br />CITY OF EVEREtt PERMIT SERVICES <br />OF EVERETT PERMIT SERVICES3200 <br />3200 CEDAR STREET. EVERETf. WA 98201 <br />CEDAR STREET, EVERETT. WA 98201425-257-8810 <br />025251-BB i 0 — FAX 025�25]-885➢ <br />—FAX 425-257-8857SITE <br />SIZE PDOflE55 PARCEL I.D. FERMI*u <br />ADDRESS PARCEL TAX I.D. # PERMIT#I`i10 <br />IYID M14NGAd A <br />NlGNCAA►ALEGAOT <br />EGP LOi NO � BLOCK iXIiLT <br />� <br />NO.IBLOCK TRACTDESC.���/3/cNcAl�OWNER <br />s�. 21 � $OiM�' 5r npc NOtA• AOD. <br />OWNER .N�PI95 ZIP PHONE <br />ADDRESS 2IP PHONE�rpSaM.�`j9?-D�ZSTENANTECONTACT <br />Croy Gal�LS saMz 98201 ZS>-9496 <br />iEN.VIi E <br />CONTACT PERMIT PHONE <br />FOR PERMIT PHONESQ^'+ <br />SwN 2 <br />�CONTRACTOR <br />COHiMCLOR IO�ME59 21V CONTR. LICEH9E• <br />ADDRESSZIPCONTR.LICENSE #PHONEPROPOSED <br />PHONE <br />USE OF BUILDINGBuildingMechanicalditior <br />PPOV0.5EO USE OF BUILDING <br />FEPNIL <br />nBuilEly M4c�anitel <br />�I)60 mpndlnn �J RYTbing <br />qr <br />WORT{ rAiteration <br />HEATSOURCE <br />�E�[N.c <br />MEATSOURCEPERMIT,FII�,((.�'.',mbinalionPlumbingWORK�IeUric�nn���O,JTYPEDemolition <br />�!/QI iI D.J <br />ry�E <br />Sign <br />Sign <br />�E <br />TYPE w,as/'�YYll/iSprinkler <br />Other <br />VOIMrONTiPCTPRICEOFWd0.M'1�����'JCT'�F <br />USPXnkleon <br />Oa�tlWlnl. <br />pair/Maint. <br />CONTRACT PRICE OF WORK '1�� ��� '— <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />EVEREilLOL4LSLLEE fRIlCG0ERN05WOgMOE5C0.1PT.lXp�OMBING <br />WORK DESCRIPT.ON <br />O_,✓10 Pi <br />PLUMBING <br />MECHANICAL <br />MECH�INICALHO. <br />LYPEp'FlAIVPFOR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />TYPE OF FIXTURE OR ITEM <br />IYVEOF FlMNREgIllFl1�WATEF <br />/ <br />CLOSET1T011Ei1NC-NHPNCLINGUNRS1 <br />WATER CLOSET (TOILET) <br />A/C - A/HANCLING UNITS <br />1 <br />BATniUB <br />BATHTUB <br />FORCED AIR SYSTEMS <br />FORCEDAIRSYSTEMSLgVATOftV <br />�WA5H BA51N� <br />LAVATORY (WASH BASIN) <br />rNO. <br />HEAT PUMP <br />HEATDUMPSHOWER <br />SHOWER <br />UNIT HEATERS <br />UNIT HEATlRSKITCXENSINNfl�I5PO5ALLLOTXISDRYERpI5HWP5HER <br />KITCHEN SINK &DISPOSAL <br />CLOTHES DRYERDISHWASHERRANGE <br />_ <br />FOOD <br />PANGE i00D.AON�RV <br />iPAY <br />_AUNDRY TRAY <br />WATER HEATER <br />WATER HEATERCLOTHESWASHER <br />CLOTHES WASHER <br />—METAL <br />FIREPLACE/STOVE <br />METpL FIREPLACEISTOVEUFINAL <br />URINAL <br />FIREPLACE II:SERT <br />FIREGIACEII:SERTORWpNGFOUNTgiN <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />GPSFlREPLACEFLOOF <br />_ <br />_ <br />GRAM <br />FLOOR DRAIN <br />_ <br />GAS RANGE / <br />� <br />GPSRANGEB.LKFLOW <br />P0.EVENTE"Y <br />B.-1CKFLOW PREVENTE-r'. <br />�SERNLE�BAWLWPiETC)'�%MFUST <br />SINK (SERVICE.'BAR/PAOP/ETC.) <br />� <br />GAS PIPING <br />GPSPIPINGSINH <br />EXHAUST FAN <br />FANiHEflOTHERiHEREBVCEiiiIFViXPiiVE <br />— <br />CTHER <br />I <br />OTHER <br />I <br />I HEREBY CERITIFY THAT I VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />REiOFx0 EL1MMEDixiSAPGLICAtIGN ANO Y.NOW iXE SAMEiOBE iFYE RIv'O GORRELi.>LLPPOVi5�0Y50F <br />PROVISIONS OF LAWS AN RIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />U\YSPN0.10iNFCESGOVEPNiNGiNi4TVPEOFWOpN WILLOECOMPETEDWiiXWXEiEPSPECiFiEO��EPE1NOflNOT. <br />NOT. THE GRANTI 0 ERMIT DOES NOT PRESUME TO GIVE AJTHORIT" TO VIOLA i E OR CANCEL THE PROVISION OF ANY OTHER <br />THEGPPNEM1I?DOESYOTGPESVAIE iOGNEAJiXORII"iOVIOtAiEORCnNCEL iNEGROVI510N 9F TNV OLHE9STATELOOPW <br />STATE LOCAL W WTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />LIiMG CONMiPVLiION ORiM1EPEPFORANNCEOFfANSiflUGtlOrv. iXPTIPM PIIiNORIZE00V MEOWNEFiry15 <br />OWNE F THIS POP T ERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />POPERFOFiXE WONtFORWMiCxPPRICPilONI5MP0E TN01fAMGLVWiiXTXESigTECOMPi0P <br />CONTR TOR AW 1 R r\' ND 296.200 WAC. <br />-� <br />rl'N1PNND:Pe.'_'OOWPC.D��wr�oiwm.aao��amonzeeagemoaie�/�DEBIT <br />Signature of wnenContracior/Authorized Agent D�� <br />f/`� <br />B CREDIT CARDS ARE NOT ACCEPTEDPERMIT <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />