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' PCAMIT APPLICATI(CJ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 <br />SITE ADD SS <br />PARCEL TAX I.D. N <br />PERMIT p <br />� <br />III au\fer 4ve: tvl¢ <br />ocyclsW oz 500 <br />ortr -o x <br />LEGA LOT NO. <br />DESC. �� <br />BLOCK <br />L� <br />�^T+R�ACT <br />i <br />O.5• <br />l_.cs t t 0 t�UZv�� <br />OWNER ADDRESS ZIP PHONE <br />R— � � ���� �ti4�h;ev t�ye evW ,gz�� c 360) 70N <br />TENAN NAME <br />CONTACT NAME PHONE <br />I CONTRACTOR ADDRESS 1 ZIP CONTR. LICENSE p <br />�i.ln s7��. c. fiJ •✓ 6 �.2 � S4 �A/2 !✓f 4g.i70 rOFA VECl 01 6 f'f <br />/j t[c✓P.r <br />PHONE 35J'6 S9'/>i� <br />PROPOSED USE OF BUILDING <br />Building fi Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination ILK-J( Pl9mbing <br />WORK <br />AlterationElectric <br />H <br />� <br />TYPEDemolitionSinTYPE <br />� <br />New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />•!� A00 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3108 <br />/ <br />WORK DESCRIPTION <br />T RepInce- <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 />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK &DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHESWASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNT,'JN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER _ <br />OTHER <br />I HEREBY CERITIFY THAT: HAVE READ AND EXAMINED THIS APPLICATION ANC KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAW:: 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 />I <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CGN TORS LLA18.27 RCW/ A 96.200 AC. <br />lure wner/Contractor/.Authorized Agent Date <br />�L <br />