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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 />Lo clock I, cc�xec zc - Gard eirI5 <br />SITE ADDRESS y 9k=lk <br />ARCEL TAX I.D. # <br />LEGAL LOT NO. <br />-r. ".'.1SHI10 Z9 RA/ JGG 04.DESC <br />'-.9 10 Tm-co <br />Ecllarl Z -4 po <br />OWNER ADDRESS IP PHONE S- 742-59 <br />RICH REN(SIOC:7 49ZZ 99MA PL s.Ul • MoKwiEY�), NIA. 987-75 <br />TENANT NAME <br />I CONTACT FOR PERMIT ,Zc&-3q(,-433z c�c- 9�' 74Z <br />RIDS REM6tWA zob- %5- 8"B a tr /ol ci pl g. <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE# <br />pp0F'b-i:!i,IONAL fA0MabUII.C)tt'^S LJ-c Z34r>l IITHAJ4',W• 535mEllIKiA 9e4ZI <br />PHONE 206-387-0920 �QpF)rF{L.tb20� <br />PROPOSED USE OF BUILDING Building I� Mechanic Addition HEAT SOURCE <br />R <br />PERMIT Combination ILH�J Plumbing (WORK Alteration Elactdc <br />Gas <br />P <br />TYPE Demolition Sign TYPE ®U New <br />Sprinkler Repair/Maint. Other <br />CONTRACT PRICE OF WORK AFtPROX. 03IAOWP�'* LQ3517— CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION Cp0�j7} G C64kj )=,6,MILy WIIF <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET ' I <br />A/C — AIHANDLINGUNITS <br />ti <br />BATHTUB li <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) `/L( <br />HEAT PUMP <br />_ <br />7 <br />SHOWER I� <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />_L <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_L <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />L <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_I <br />GAS PIPING <br />EXHAUST FAN "; J <br />SINK (SERVICE/BAR/MOP/ETC.) <br />I <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 LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOP','ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH l"HE STA. <br />CON ORS 27 RCW AND 296.200 WAC. <br />/QvGmir 20 z cb3 <br />Signature of O r/ ontractor/ homed Agent Date /a <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />