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(FRMIT APPLICAI�JN <br />4077 CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT, WA 98201 <br />425-257-8810 — c AX 425-257-8857 <br />SITE ADDRESS �7 <br />7DOD P p IeDESON /BOA1 <br />PARCEL TAX I.D. A PERMIT N <br />IS Da/ - <br />LEGA LOT N0. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />(.OMMUNdy 7/X fIACDF%aV 425--3g5-,? <br />TENANT NAME <br />commutdy l NS/� I <br />CONTACT NAME PHONE g 4 S b s Z T S 3 <br />DAuF wvE� 4z5=837-777-0 <br />CONTRACTOR _,e, DDRESS ZIP CONTR. LICENSE N <br />r7c'ACOnC/ LLC/�. llo S/1✓�A ra.All <br />94SDZ 7 5eA CO- 01 Z <br />/GE,i /^ <br />RHO4Z C ' O'L_7_ —l7Ly i SSi^'?U%fr^ J 141A ' <br />PROPOSED USE OF BUILDING <br />PERMIT <br />wilding Mechanical <br />Combination {R.( Plumbing <br />Addition <br />WORK Alteration <br />MEATS URCE <br />Eiectnc <br />���j• �jC <br />TYPE <br />Demolition Ij Sign <br />TYPE New <br />RepairiMaint. <br />Gas <br />Other <br />Sprinkler <br />CONTRACT PRICE OF WORK / 771 �2D � ',00 <br />112�0 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />f� <br />WORK DESCRIPTION `p./$ UGY7ON GiF /1 %�i4 EIVOfAf& ME%Ar <br />eRI ArlP. GEC. <br />3Z00 5Q- FT, NO LAIATER- 56RV/CCl /JD -6e IaD <br />sFQI/ICE, aUIL'p/i14/LT DN E.r15T/n4 S GONC s <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />UNIT HEATERS <br />I <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />— <br />CLOTHES DRYER <br />DISHWASHER <br />LAUNDRY TRAY <br />NGE HOOD <br />TER HEATER <br />CLOTHES WASHER <br />_ <br />ME FIREPLACE/STOVE <br />URINAL <br />— <br />FIRER CE INSERT <br />DRINKING FOUNTAIN <br />— <br />GAS FIR LACE <br />GAS RANG <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />— <br />GAS PIPING <br />EXHAUOTHERST FAN <br />SINK (SERVICE/BAR/MOP/ETC.) <br />I <br />OTHER <br />— <br />1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISION F LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL SE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE R TIN Of HMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR OC L L ATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT [AM AUTHORIZED BY THE <br />OWNER OF THI P PO PERFORM THE WORK FOR WHICH APPLWDE AND I COMPLY WITH THE STATE <br />CONTRACT R LA 1W AND 296.200 WAC. <br />Signalurenen or/Authonzed Agent 1 <br />FUW <br />q <br />M <br />