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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 ADDRES <br />PARCEL TAX I.D. k <br />P . MIT N <br />7903 I I�.f4D Da <br />3t 3�100 �0iZ01 <br />�2G4 Z�05 <br />LEGA LOT N0. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />I -Dray JoN>"s 7603 1A(&HLAAv4r, 425-436-04i2 <br />TENANT NAME <br />CONTACT NAME PHONE <br />I <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />STt=`L C �i�nc, Cd�1sT <br />Bk <br />PHONE Sr�tNWODp WA-gBZ4Z }3K�`T�'F�151Ks' <br />425.327 8 1 li SAS LI' 1 5 ( <br />�PRrOPOSED USE OF BUILDING <br />(- AI iK^'t <br />Building Mechanical <br />PERMIT Combination fR( Plumbing <br />WORK 1P..L <br />Addition <br />Alteration <br />HEAT SOURCE <br />Q Electric <br />1-�L-T�NE`� <br />TYPE Demolition LJ Sign <br />TYPE J�$t <br />New <br />Ges <br />Sprinkler <br />�J Repair/Meint. <br />u Other <br />CONTRACT PRICE OF WORK 2Mt CJ � <br />O J�^-' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION 2 `�/� <br />)(2 4)(6gcyt 6 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. I TYPE OF FIXTURE OR REM <br />_ <br />WATER CLOSET <br />A/C - 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 />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LA( NDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />I <br />OTHER <br />OTHER <br />1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAV/S 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 />CO ACTORS W 16.27 /W AND 296.200 WAC. <br />Signature of Owne ontracto uthorized Agent Date 1/L <br />