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PERMIT APPLICAI ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4225-257/$810 - FAX 425-257-8857 <br />Ui r/o//ir <br />SITE ADDRESS <br />r PARCEL TAX I.D. # <br />PERIAT-# <br />7/-7 <br />Gr>> 9-3 00 <br />LEGAL LOT NO. <br />BOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />A r <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE <br />__ + ZIP CONTR. LICENSE # <br />CONTRACTOR �-C^� 9C�r>,,c3rr, ADD ESS �,r� v� <br />t/ S /03 <br />,j ATE T 10L-T—U l IS G <br />U <br />PHONE 7ps- %J 7 7 V y)— <br />OPOSED USE OF BUILDING <br />Buildin Me, <br />HEATSOURCE <br />V'rT 6 f T <br />PERMIT <br />TYPE <br />(� Combination Plumbinigcal <br />F� <br />FL-J1 Demolition Sign <br />TYPE <br />ry, <br />KKLLY1J( New <br />R Gas <br />(WORK <br />Repaitjon r/Maim. <br />LLLJJJ Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION n �.�// J�7 ' <br />I <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />NC-A/HANDLING UNITS <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />SHOWER <br />_ <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTErR <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <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 ORIOINACES 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 OTHU <br />STATE OR LOCAL W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS OPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTPRW 18ewAND 296,200 WAC. <br />Sig ure of Owner/Contractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />