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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREFT, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI i# Da_ �� <br /> ao YYlonroe O SW D - 0�7- 030- Do � <br /> LEGA LOT NO. BLOCK TRACT r Ir <br /> DESC. O I 3� a.7 inelvrst D � b 353� I9S�7 <br /> ON'NER ADDRESS ZIP PHONE <br /> J�Q � �GfV Il n5-1 �Lt/�517✓f ���� / � VJ�1��- y 8a°3 PNONE <br /> TENANT NAME CONTACT FOR PERMIT <br /> dP i r�1�.M C hn5+,��5�i� WI �k� I.�.fs�,� '�a.s- 3a7- d535 <br /> CONTR� AODRESS ZIP CONTR.LICENSE# <br /> .Carse.� C�,,,sF 3io i4l�ers�-� 6I�d £vercFf W►4 qYao� <br /> PHONE ��RSEC– � � OI L � <br /> tia,� 3a� a535 <br /> PROPOSED USE OF BUILDING � Buildi�g (") Mechanical AtldiGon HEAT SOUf2CE <br /> PERMIT Combi�alion ��} Plumbing WORK � AlleraLon � Elec'ric <br /> TYPE Demolilion � Sign 7YPE New Gas <br /> ,5�C '` f Sprinklef Repair/Maint. ONer — <br /> W�ti.l <br /> CONTRACT PRICE OF WORK ���Q � � CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 — <br /> WORK DESCRIPTION <br /> �t !�� I� (�� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXNRE OR ITEM <br /> WATER CLOSeT(TOILET) _ AIC-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEAT�RS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER ,_ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> 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 8E COMPLIED WITH WHETHER SPECIFIEC HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT UOES NOT PRESUh1E TO GIVE AUTHCRITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUTATING 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 t COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW ANO 296.200 WAC. <br /> �,,,� <� a-s-o�i <br /> Signature of OwnedConlractodAul orized Agent Date �� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />