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P"RMIT APPLICATKA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />P RMIT N <br />7/000c2-f0/ <br />6 3 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. LO <br />D -O / <br />�.Ar--e-p��, <br />,Q I�C-L9N () ) �7 CA 'f" / "/"" O r'EG t <br />OWNER ADDRESS ZIP PHONE <br />pjL-rt0 L . Joi4r/So.4 (s,P�-) (m) 3y7 -355S- <br />t <br />TENANT NAME <br />CONTACT NAME PHONE <br />�,^-c n P; f►. 1. q. 3 f b -3973- <br />I <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE M <br />PHONE <br />PROPOSED USE OF BUILDING <br />I PERMIT <br />n Building Mechanical <br />Combination Plumbing <br />Addition <br />WORK Alteration <br />MEAT SOURCE <br />Electric <br />5. �. <br />TYPE ,{{LHJ( <br />Demolition Sign <br />TYPE New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK +� o Jd <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />(eZ 3 S /Aon,7o,� (or Z l Fie �j) N iidT.L e.}� 13f� j l�°A14 <br />W. F- / J j . H`R�Y�J /} t4A> / r won. t Or= h/JJwc-` r "f4 E"t-J <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ <br />A/C - AJHANDLING UNITS <br />_ <br />BATHTUB <br />— <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />— <br />HEAT PUMP <br />_ <br />SHOWER <br />— <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />DISHWASHER <br />I_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />— <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />— <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />— <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />— <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />— <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />—GAS <br />PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />— <br />EXHAUST FAN <br />OTHER <br />— <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 PROPEPERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS NO2 0 WAO. <br />t�FCW <br />Si ner/Cd tra uthorized Agent ate 1/ <br />` <br />