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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 <br />PARCEL TAX I.D. N <br />PERMIT 0 <br />/� <br />'i9/O k/ L41e' ; Pr <br />I <br />MDLo 3-W5 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DES O. <br />OWNER ADDRESS ZIP PHONE <br />Pc?.,/,, /J'/oGlf N4/U4 U,lc.,P- Eucre,+9 95,o03 11S- 3`>✓>-415 a <br />TENANT NAME <br />CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE M <br />E✓{r5rcv� J/->t 5/.e rl /7., for lGI/P_ h'/o ri %r.e (/, t... /7r E✓C�17y 9i�cl 5$Gi70 <br />CU,cX6 <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building �,a'Mechanic7' <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R CombinaLon TFL--(IC Plumbing <br />WORK <br />R Alteration <br />f� Electric <br />TYPE. <br />B Demolition Sign <br />TYPE <br />Ir�j New <br />FL$-J(eGas <br />Sprinkler <br />L.. RepaireMaint. <br />Other <br />CONTRACT PRICE OF WORK -3/00 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />UNITS <br />_ <br />_ <br />BATHTUB <br />—% <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 UISPOSAL <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 />I <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP;ETC.) <br />_ <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CFRITIFY 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 TC PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CUNT RACTORS LAW 18.27 RCW AND 296.200 WAC. <br />T ? -G. -O;- <br />Sig ure of Uwner/Gontractcrr/AUthonzed Agent Date <br />L <br />