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'EPMIT APPLICA770N <br />04FW77- 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. # PERMIT a <br />3yrt� r�r��s��zrrr. rno3o5--ca3 <br />LEGAL LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />4)aar�-1 M-:61"'J -3 yrsr 96•ao/ y-.7 5- 7- 7.) <br />_j <br />TENANT NAME <br />CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE M <br />EU5/jL•r.- 5/,7< SA—t` M��"•l /L/iFMo �- �/.e� 4sau �u�nGsSoaavY <br />PHONE <br />y.a3--.�s�- 3��� <br />PROPOSED USE OF BUILDING <br />Building <br />Addilion <br />_ <br />HEAT SOURCE <br />PERMIT <br />R Combination�Pl,�ectlamcal <br />umbing <br />WORK <br />Alteration <br />Z Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />B New <br />Gas <br />Sprinkler <br />Repair/Mainz. <br />Other <br />CONTRACT PRICE OF WORK 061.57 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C—A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK v DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <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 />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 1 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of OwneuConlractor/Authorized Agent Date <br />