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P"RMIT APPLICATION <br />0:7r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS r PARCEL TAX I.D. N PERMIT a <br />I <br />✓lY' <br />UEGAIJ LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE _ <br />Z�J��AVC bu-K.1t ux- °AIL <br />TENA':— NAME CONTACT NAME PHONE <br />C-N: Z j 1_ - N i, C. <br />CON(TR.LIC�ENSE 4 <br />CONTRACTOR,, �V.Z�S �L.,�AODRESS 2.tdqjlro _12:1.tv CNC <br />Wv \` <br />QZIP <br />PHONE �1�11u��'Ot) VjL, QLZ�3 �*D4>WM��Y'7 <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />IR( Combination Plumbing <br />WORK <br />Alteration <br />I[-)),�ectric <br />TYPE <br />11r-,(( <br />�j Demolition Sign <br />TYPE <br />New <br />Gas <br />u Sprinkler <br />Repair/l, <br />Other <br />CONTRACT PRICE OF WORK 2 /r.r� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION '_ c <br />& <br />PLUMBING —r <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVA10HY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & 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 />FLOOH DRAIN <br />�_ <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 KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES OVERNING 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 1-0 VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR L W REGULATIN(' CO TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER O T S PROP TY TO E FO 7 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAf S 7 J 2 200 AC. <br />Z o2 <br />Signature o eA' t actor/ Ih rued Agent Date <br />