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PERMIT APPLICATION <br />0017'r CITY 01 EVERETT PERMIT SERb ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />5- / <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT rr <br />/8, 7 /!C//c' ✓ c/a/E f< OdS 7%OOObZ 105 +��` <br />LEGA LOT NO. BLOCK TRACT <br />OESC. <br />OWNER ADDRESS ZIP PHONE <br />JAe"/1r.'Fs COii/Siell iPprt/ /A/C 20L1/ aD1hr/l%Er.t!! hwv &ii))erl ."'06,11 <br />TENANT NAME I CONT CT NAME PHONE <br />Vv/1'riP riGsiOEycC 0/IlilhcA 1Llil;ct/J �/L5iv53-5�S7 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE M <br />/lJd/INIGU Firl[ PRDiECiivN 1�? /Z eox 1593 <br />PHONE yL5)v.k3 selbt/aod,rlv;lle WA % �'1Z ftJ✓ANFPl9�/!3E <br />l <br />PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br />PERMIT Combination IIL--J(( Plumbing WORK Alteration n Electric <br />ryC'S;Lfeq>/G� TYPE Demolition Sign TYPE New B Gas <br />Sprinkler Repair/Mainz. Other <br />CONTRACT PRICE OF WORK Q' �J0 CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />nvnn ucaunir r wn <br />OF a clew sp/io0el sysir'm. <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOV <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />OTHER._ �4 <br />EXHAUST FAN lr <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />— <br />— <br />_ <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 LAW 18.27 RCW AND 296.200 WAC. <br />,2/)<i %JC i) Ali /1<r) Kl- 0- <br />Signature of Owner/Contractor/Authorized Agent Date <br />tl'Z <br />