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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 I PARCEL TAX I.D. A PERMIT N <br />zml& lll`slt /J/��c I n,oabz ol,? <br />LEGALL LOT NO. BLOCK TRACT <br />/C, c¢/i'CC/C/ AUe. /, -/� /(G : i s-/k I-)Iaee <br />TENANT NAME / / / I CONTACT NAME PHONE <br />CONTRACTOR ��lj� �iUgQL/C & ADDRESS J �y <br />�J /-U./jjt�.iC LP CONTR. LICENSEN <br />PHONE ;'W ..s61S- <br />PROPOSED USE OF BUILDING <br />PERMIT <br />I <br />Building j7��lecbanical <br />R Combination Pl9mbing <br />Addition <br />HEAT SOURCE <br />Electric <br />TYPE <br />B Demolition Si n <br />B <br />(WORK Alteration <br />TYPE New <br />Sprinkler <br />Repeir/Meint. <br />Other <br />CONTRACT PRICE OF WORK o:}'L1 S / <br />CITY OF EVERET LOCAL SALES TAX CODE IS 3105 <br />C 0)Lz.49e000/ 0/ C-f/3", n/(- i-e,60-4te-e- 4?I4Q <br />of /7&) �I9yl >cA/6/CV' D/c f7U'/lReL, 0/� f �tLCI CULL 11�tC �l5/J, <br />duc�iiry u.cd `c�a� ids <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <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 />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />_ <br />_ <br />_CLOTHES <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />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 />1 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 AUTHORIT•f 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 TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAQTORS LAW_ 18.27 RCW AND 296,200 WAC. <br />a -le <br />