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�)ERMIT APPLICA 'ICON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. R <br />-3'42C CAtS I ooy38� QZOU 23�0 f�l7 S -0/ <br />LEGA , 1 [B.,LOCK^ TRACT <br />LOT NO, <br />D G4 23 t; Zy C.` mil.' (I {-cZ� (=F EUCRCI�1 U�V1 SIoa r� VO�P �P ON <br />OWNER ADORE J <br />fy�I ke I- h 342D 04Kes <br />CONTACTNAME PHONE ��yy ff�� <br />TENANT NAME Z1 3- G-CCE <br />M 1 Kc 02 <br />CONTRACTOR _ ADDRESS nn ZIP CONTR. LICENSE p <br />��l I` CuStem �ulkLNys/ /n�. Q. /,OX 2- <br />PHONE 11 <br />PROPOSED USE OF BUILDING <br />Building <br />(7 g <br />Combination <br />�] <br />U <br />Iv�echanical Addition <br />Plumbing WORK Alleralion <br />HEAT SOURCE <br />Ii Electr,c <br />CJ r�( (� �t <br />PERMIT IIFL"--ll(( <br />TYPE Demolition <br />Sprinkler <br />U <br />Sign TYPE New <br />Repair/Maim. <br />Gas <br />IIL-.mil( Gas <br />Other <br />PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />CONTRACT <br />WORK DESCRIPTION f // <br />I c h."..w 11 �2 30 )U0 �AenSN _ (cl<n OC/nAl2C �zC� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM NON e <br />NO. TYPE OF FIXTURE OR ITEM /Y14)lJr <br />CLOSET <br />A/C - A/HANDLING UNITS <br />WATER <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_ <br />_. <br />_ <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />_ <br />_ <br />_ <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />_ <br />_ <br />CLOTHES DRYER <br />HOOD <br />RATER <br />_ <br />_ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />FOUNTAIN <br />_ <br />_ <br />_ <br />_ <br />WATER HEATER <br />METALFIREPLACE/STOVE <br />E INSERT <br />FIREPLACE <br />GAS FIREPLACE <br />_ <br />DRINKING <br />FLOOR URAIN <br />BACKFLOW PREVENTER <br />_ <br />_ <br />GAS RANGE <br />GAS PIPING <br />_ <br />_ <br />_ <br />SINK (SERVICE'BAR/MOP/ETC.) <br />OTHER <br />_ <br />EXHAUST FAN <br />OTHE7_ <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CUHHtU I . ILL <br />PROVISIONS OF LAWS AND 0910INACES 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 PROVISIC14 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 PROPERTY TO PERFORM THE WORK FOR WHICH .APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />5/ ?/03 <br />