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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 />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT x <br />-704-ifoela T IVIE <br />holy oio anal <br />C2-tom/d <br />LEGA LOT NO. <br />BLOCK <br />rRACT /7 <br />_ <br />OWNER ADDRESS ZIP PHONE y,s, <br />(1(0 1y1m e s. JA /OLD/1-/-W14AVPIc%F 3y5-U&63 <br />TENANT NAME <br />CONTACT NAM �� PHONE <br />dl4 --Z ��'.�n/� ✓ I <br />6f�2 y @ '� �/ zs) 3y�=GAG 3 <br />CONTRACTOh ADDRESS <br />6)0C f {G7Nes1 �Nt�/ ! I1>fk�? /S✓/!-Gr CONTR. LICENSE N <br />9P <br />ZC) (j)eC*1*j7%NrA <br />PHONE 7 <br />-JZ-s) 3 <br />PROPOSED USE OF BUILDING <br />��9 �,E Tj4w 16-l/ <br />Building Mechanical <br />PERMIT Combination R Plumbing <br />TYPE 6 <br />Addition <br />WORK gAlteration <br />HEAT SOURCE. <br />Electric <br />/ <br />Demolition Sign <br />TYPE New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK fi 7C� 03z) , G'n <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />9 <br />WATER CLOSET <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />'— <br />HEAT PUMP <br />_ <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />—_ <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />LAUNDRY TRAY <br />CLOTHES <br />�— <br />WATER HEATER <br />WASHER <br />"— <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />-:t77 <br />GAS RANGE <br />GAS PIPING <br />SINK (SERVICE/BAR/NIOP/ETC.) <br />EXHAUST FAN <br />I <br />OTHER <br />-= <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 />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 LP CAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER F HIS PROPERTY 0 PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT ORS LA 16 27 AND 296.200 WAC. <br />gignatu 7u wher/Contractor/Authorized Agent Date <br />iL <br />