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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 />SITE ADDRESS PARCEL TAX I.D. /F PRMIT # / <br />�•cc uc- Oc`y35"-13CJ 10 f� ��—�cl <br />LEGAL LOT NO. BLOCK TRACT <br />UESC. 1, L, 3 r.l ti <br />OWNER ADDRESS ZIP PHONE <br />i?o6c i /$C/ I11`L)01-y4// A,� �SJtI �)25-.�55 ti'l76 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Sa re bkuV'& w6lov' 4-I'6'fO <br />CONTRACTOR ADDRESS L'P CONTR. LICENSE # <br />Qc4/ 2EJ.5 c •I(e/ A.� <br />PHONE Ste sf-JIy dR5DL1 0L.�(jac.6�d5cZ. <br />PROPOSED USE OF BUILDING <br />G <br />PERMIT <br />irI <br />rCombinationU Plumbing at <br />WORK <br />dition <br />I- <br />HEATQSO QR� L IA1 <br />In <br />a rq i t <br />TYPE <br />Demolition U Sign <br />TYPE <br />}Lq, New <br />Lj Gas <br />le <br />Repa r/Maim. <br />LJ Olher <br />CONTRACT PRICE OF WORK 7 /�' Z CITY OF E-Vt RETT LOCAL SALES TAX CODE IS 3105 <br />J <br />WORK DESCRIPTION <br />F'0 /c g „Id; w y . co }I 3 o <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILtT) <br />A/C - A/HANDLING UNITS <br />E�IATHTUB <br />FORCX <br />SYSTEMS <br />_T <br />LAVATORY (WASH BASIN) <br />HEAT <br />SHOW R <br />UNIT S <br />_ <br />KITCH SINK &DISPOSAL <br />CLOTER <br />_ <br />DISHWAS R <br />RANGD <br />LAUNDRY T Y <br />WATEER <br />_ <br />CLOTHES WAS <br />METALACE/S <br />URINAL <br />FIREPNSERTDRINKING <br />_ <br />FOUNT 1 <br />GAS FCEFLOOR <br />DRAIN <br />GASRBACKFLOW <br />PREVENTER <br />_ <br />GAS PSINK <br />(SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHANOTHER <br />OTHE <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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />ONTRACTORS LP W 1827 RCW AND 296.200 WAC. <br />SignatUre of Own ntractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />