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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. B I PERMIT a <br />/ -) 16 /c/fs-/lJD,t <br />LEGA LOT NO. BLOCK I TRACT <br />OWNER AUUKL55 z 7c' cf. /,S-) ur rnvnc <br />e-' `�`�.li iras' <br />sir <br />TENANT NAME CONTACT NAME PHONE <br />CONTRACTOR ��'nJNrc.G. ADDRESS / Z'IP/ CON4R.UCENSEt1 <br />z i0 7 � �O � �/it�t H G✓Q �AQ <br />PHONE Z� -2 <br />PROPOSED USE OF BUILDING Building fl Mechanical Addition HEAT SOURCE <br />/� PERMIT RSprinkler <br />Combination Il,( Plumbing WORK Iteratbn R ElectricTYPE Demolition Sign TYPE New Gas <br />(M of heads) Hepair/MainI. LJ Other <br />CONTRACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION C � �r-5�r�7 <br />c <br />c�lr E <br />�.-f�-/r <br />,i:.✓ r-+-r•e�o7r.�s cCL <br />.L' <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />RA -.!(FLOW PREVENTER <br />SINK (SERVICE/BAR!A4OP/ETC.) <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />__ <br />_ _ <br />__ <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER -- <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 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 OI, 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 --OM?LY WITH THE STATE <br />CONTRACT6RS-LAW.-1827 RCW AND 296.200 WAC. / <br />ontractor/Authorized Agent / Dale' <br />