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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />ZJJf <br />SITE ADDRESS <br />PARCEL TAX I.D. M <br />PERMIT e <br />l5o F}A2DLSCt4 IZDA.r�) <br />07$041:z17t1ZoogDC) <br />SL <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />OESC. $ <br />5P NO 5-1-7 I�Z <br />OWNER ADDRESS ZIP PHONE <br />ZI' I,,>Ii <br />uLAI<EL�� �oCK No'OINKS �-LL 321 Hiho&woL�D lAIt`\t5YtD6E W IS g13)1D <br />TENANT NAME CONTACT NAME PHONE <br />561 U/a%i TT1 54AA M 11_£-fz- <br />t2 7] <br />E^ <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE Y <br />JStVVrZ%At_ JJI£{ HA,UIOAL- $JC . 60-, IPC. <br />`1 <br />PHONE ias-S8s'9[cc $COI lfJlll[:�il5 �O IZfJ/'1CI,lL) W� ��6G5�, • UN�U�.M5�32 <br />PROPOSED USE OF BUILDING <br />Budding (R{ Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination IIL--J1( Plumbing <br />WORK <br />Alteration <br />Electric <br />1IF'S"�), <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gas <br />WA.'¢IE WSE �oFP1Cti. <br />Sprinkler <br />Repair/Maim. <br />v Other <br />CONTRACT PRICE OF WORK 3A 169D <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION (NSTA\L (nM "41i',Nt' tlfATttts 1 Fwcao AlR $y STf.PA. INSTAU- -vw (2) 16r.MA�T 'FANS <br />Z*N uSt; . 11=STALL 0µf(1) NE"1 `JNIT HL-A�'t2 <br />IY\T4 v ,41, Nrn. Irl5TA11 cNE(1) 5oFP L4 FAN T<. IWlk <br />pN6 (1\ .i.0 to r4. /1.'tc F� iam TA,n ! ��v-A r.IT 1•. Ll li' I,IITM Al\ <br />- <br />�F�oCrKe oNE (`� VN\� NE ATEZ. 11\1 mT <br />AsscCIAPEJ 17 t_MT ..�c czK �N� DIFFUSERS <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 - A/HANDLING UNITS <br />_ <br />BATHTUB <br />_L <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />1 <br />UNIT HEATERS-W•�('sE1.aA� <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHES' <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 />�_ <br />GAS PIPING <br />_ <br />SINK (SERVICEiBAR/MOP/ETC.) <br />2 <br />EXHAUST FAN <br />_ <br />OTHER <br />1 <br />OTHER sx'LYFAJ �� <br />-- <br />�Mt JEetr`w\C� <br />I 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 OH CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW R -GULATING CONSTRUCTION OR THc PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PRO TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L. 27 RC'A' AND 296.200 W''A//C. <br />l 4;' 4/AEI f 2 Z-S✓.✓t <br />Signal bI OwneriContractoCAuthorized Agent Date (/y <br />