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' 'ERMIT APPLICA 6 <br />.0N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 <br />- FAX 425-257-8857 <br />SITE ADDRESS <br />�'?y/(� R0cIteFGL-LE2 <br />PARCEL TAX I.D. 8 <br />PERMIT e <br />?oaia-oo-7 <br />LEGA �LOT,NO. 7 BLOCK <br />OESC. 12- %%` 2 -2-ta rI OZ <br />,T <br />TRACT <br />/ / <br />b ) L h V Or 6 & t . <br />OWNER ADDRESS I ZIP PHONE <br />yl <br />12L, Rothroc'L 5// CoLey rIVL tvt�CCia <br />J-- Pe O <br />Itdu!yY + -I <br />TENANT NAMr_ <br />CONTACT NAME PHONE <br />Me-Wl' o ILotkrod <br />J-%}Gtl-- fZTIC � 0 2vc- �o/�"1) <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE k <br />CUp,TIS IIZo8eP-TS CoN97'2t1CT10N P.o.20X lad'(c ISOOkITi Pl-0LRoackc.+� <br />PHONE <br />Na S-- a S?- 3 y o b <br />/ oy3KL <br />CAP. ?/7/0Y <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />_ <br />�r 5 16L N T / 6 <br />PERMIT <br />TYPE <br />R Combination Plumbing <br />B Demolition Sign <br />WORK <br />TYPE <br />Alteration <br />New <br />Electric <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK �%/ yS0 . — <br />'%7 / <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310S <br />WORK DESCRIPTION <br />CONTAAr-TD/Z Ili Cu2T IRCIO3a0r <br />RLPLACE STEEL PIPt <br />ExP to/!/oy <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO, TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C - A/HANDLINGUNITS <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS <br />X <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />�C <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />�C <br />VRINAL— <br />_ <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 />EXHAUST FAN <br />OTHER <br />OTHER <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 OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TOP FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27- D 296.200 WAC. <br />f <br />o75 JC c <br />Si alure of 0 ontractor/Authorized Agent <br />Date <br />