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M I' <br />'r ERMIT APPLICATi <br />JIN <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 />PARCEL TAX I.D. # <br />PERMIT a <br />3 /��a�,1 �,W Cc1 <br />O� St�E' lu 13 2- oo� �o <br />CG 3-p <br />N �-LEGA LOT NO. <br />DESC. <br />BLOCK <br />TRACT <br />OWNER ADDRESS 21P <br />uPH.,ONrE <br />C"`rls Ct�1c, JIUIIUI �rlc,pr� 623 n,1a�ds>y Lni„o C/�-ZS`1-`i)33 <br />TENANT NAME I <br />CONTACT NAME PHONE <br />C�QNT ACTOR ADDRESS 21P CONTR. LICENSE M <br />f`f1j4'c.rsri„ Co•,s�+t1��'a, iv.v..P/a-..,. I ill- 3L� Air, C1l�h2 <br />Zk <br />PHONE <br />_ Zcb - �4I-5z>m <br />PROPOSED USE OF BUILDING <br />I� Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />1fL�c-Jf(r Combination P Plumbing <br />WORK <br />Alteration <br />Ii Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />� <br />rLK-l1 Gas <br />Sprinkler (b of heads) <br />Popmr/Maim. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) A/C—A/HANDLING UNITS <br />BATHTUB � FORCED AIR SYSTEMS <br />�— LAVATORY (WASH BASIN) 7 HEAT PUMP <br />� SHOWER -� UNIT HEATERS <br />KITCHEN SINK &DISPOSAL CLOTHES DRYER S� <br />DISHWASHER RANGE HOOD <br />LAUNDRY TRAY 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 />_ <br />SINK (SERVICE/BAR/MOP/ETC.) FAN <br />—EXHAUST <br />OTHER p OTHER <br />I HEREBY CER171FY THAT I HAVE READ AND EXAMINED THIS APPLICATIC ..JD 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 AUTHORIZED BY THE <br />OWNE(; OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C (/1RACTPJ LAW 16.27 RCW AND 296.200 WAC. <br />�lgnaturE6t L9cvner/Canttactor/Authorzed Agent -� a� <br />