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APPLICATION <br />APPLICATONC�IYOFEV¢PER <br />CITY OF EVERETT HERMIT SERVICES <br />YERMIi�S¢PVyCE80�AUu.n�L�.11W�m•••K�,N <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT r< <br />Q�a.t..o Avg-�c2-- <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER i ADDRESS n�JC G�L S'o, I PHONE <br />�r �/'� <br />•Ld�es?�.c_T� ' ,�-.c'�1�� L�.a . 9�/�f �/ �,2olc-.373-5'393 <br />TENANT NAME CONTACT NAME <br />��I�� �j PHONE <br />�Qc%/L''t I <br />L.lC.r AL' o "Gtr�C /�� v(i/� 3 <br />-3z3-5 93 <br />CONTRACTOR L' <br />�•� <br />ADDRESS o20(e U'EM�K � �l/ � CONTR. LICENSE • <br />PHONE 3G o— ?`1'7- <br />I. � � �.�� 9Y3�S' �tsi L/��AioS.sD4{ <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical Addition HEA OURCE <br />Combination Plumbing Wppl( Alteration <br />R <br />TYPE <br />El�y� <br />Demolition Sign TYPE <br />New Gas <br />Sprinkler Repair/Maint. UUu Other <br />CONTRACT PRICE OF WORK S O oO <br />CIT'! OF EVERETT LDCAL SALES TAX CODE IS 370.5 <br />WORK DESCRIPTION ��3•i tiCC �C.tT �-r?0 � oC <br />A,r� <br />LUMBING <br />ME HANICAL <br />NO. TYPE OF FIXTURE Oq ITEM NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />A/C — A/HANDLING UNITS <br />_ <br />LAVATORY (WASH BASIN) <br />1� <br />FORCED AIR SYSTEMS <br />SHOWER <br />HEAT PUMP <br />_ KITCHEN SINK 8 DISPOSAL <br />UNIT HEATERS <br />DRYER <br />DISHWASHER <br />LAUNDRY TRAY <br />_CLOTHES <br />RANGE HOOD <br />_ <br />CLOTHES WASHER <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />_ URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENiER <br />GAS RANGE <br />GAS PIPING <br />FINK (SERVICESAFJMOP;ETC.) <br />� <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />WORK <br />WILL BE WITH <br />NOT. THE GRANTING Of A PERMIIT DOESNOT PRESUMEITO GPVEO AUTHORITY TO COMPLIEDWHETHER SPECIFIED <br />OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. <br />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 ROW AND 296.200 WAC <br />Signature of Owner/Contractor/Authonzed Agent Date <br />