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PLAMIT APPLICATICd <br />4:7r 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. N <br />RMIT + <br />_ G G�.S��J�O/6iNC // r✓ D <br />LEGA LOT NO. <br />DESC. <br />BLOCK <br />TRACT�) <br />OWNER ADDRESS ZIP PHONE - <br />TENANT NAME <br />CONTACT NAME PHONE <br />��FZ /J' �.n <br />f ../ /� a TiFI.✓ <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />PHONE 5.--/z /LG.5 -- �- �•� <br />fve-�.0 Cv a2 <br />PROPOSED USE OF BUILDING <br />/ <br />��G� <br />PERMIT <br />TYPE <br />Q'ftilding j"� Mechanical <br />I j Combination ILHJ( Plumbing <br />B Demolition Sign <br />Add�lion <br />WORK �Niteralion <br />TYPE B New <br />HEAT SOURCE <br />Electric <br />as <br />O <br />Sprinkler <br />Repair/Maint <br />Other <br />CONTRACT PRICE OF WOR % yG. G <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/ <br /><.z,-LE, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP: ETC.) <br />_ <br />EXHAUST FAN <br />OTHER <br />OTHER — <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND ti NOW THE SAME TO BE TRUE AND CC'RRECT. 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 P99OPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS l" N AND 296.200 WAC. <br />Signature of Owner/Contraaor/Authonzed Agent Dale ^ <br />GS <br />