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r <br />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 />'gCA-1, A , <br />PARCEL TAX I.D. # <br />o°`123G 1. <br />PERMIT M <br />i11031G <br />«/l/� <br />a000NSo� <br />p <br />LEGAq LOT NO. <br />BLOCK <br />TRACT �//y G.��eve <br />DESC. <br />- <br />OWNER ADDRESS DP <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />lle /k "i� - �aE- y <br />cog <br />CONTRACTOR ADDRESS LP CONTR. LICENSE# <br />PHONE c.W.��� �,i�-��.,� L� �Scya, �'%,.Tr✓r/v�GC E'� <br />PROPOSED USE OF BUILDING <br />PERMr <br />Mechanical <br />Combination <br />Building 9Sign <br />Plumblhg <br />.�II�j <br />Addition <br />HF'JTT=(($OURCE <br />Electric <br />� <br />TYPES <br />ITYPEKK <br />�rLJ <br />\ <br />IRK-( <br />Demolition <br />wiNMalnt. <br />I-( GGas> <br />Ll <br />U Other <br />CONTRACT PRICE OF WORK / G> � � �3 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />m <br />.L r, e�%n �/ I•��� i7 Lw /. n,_/j Je ��el.��, n�i `ln/t/i�/ � /L.. '7` � �a l7 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />A/C -A/HANDLING UNITS <br />_ <br />BATHTUB <br />_I_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WAR! i BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINKS DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />— <br />LAUNDRY TRAY <br />__ <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <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 />OTHER_ <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED PHIS 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 PRESUI IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION )R THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORM FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACj9RS LAW 18.27 R W AND 296.200 WAC. <br />Signature of OW e'r/ ontractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />!I'\&!--q0-0C) j <br />