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P'LRMIT APPLICAT16N <br />CITY OF EVERETT PERMIT SERVICES' <br />3200 CEDAR STREET, EVERETT, WA 98201 1 <br />425-257-8810 — FAX 425-257-8857 _ <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />XRMIT a <br />(, LI F r - <br />0 , 176 <br />LEGAq LOT NO. <br />BLOC <br />TRACT _ <br />rrE / 5 1 —'L — 9 9 <br />DESC. <br />- l <br />5 <br />OWNER ADDRESS ZIP PHONE <br />L 337 5,2-73 <br />TENANT NAME CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />COEAizER, ,k6' -5,4, ,,,�y� 3 �✓ �z 5� 13208 GoegTil � oa11 ccl <br />PHONE <br />PROPOSED USE OF BUILDING Ilding fl Mechanical Addition HEAT SOURCE <br />PERMIT IFK�(-$Combination 41L--J{( Plumbing WORK Alteration Electric <br />��1111{ <br />TYR (� Demolition Sign TYPE -New as <br />Sprinkler � Repair/Meint. Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />Z4& L 2235— <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />ip <br />WATER CLOSET <br />A/C - A/HANDLINGUNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />6 <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />o2_ <br />RANGE HOOD <br />�2 <br />LAUNDRY TRAY <br />a _ <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <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 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 />CONTRACTOF� UL71�(J 18.27 R 96.200 WAC. <br />I �(�Yl/�/�/ /7_..e IL / it Zi <br />-bale <br />Signature r ontra t¢r/Authonzed Agent t <br />2 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />