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I <br />L <br />F _:RMIT APPLICATk N <br />elLm 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. M PERMIT K <br />/ or sT- <br />00&i9 3,-4G 00 7 00 oac�6-o <br />LEGA LOTNO. <br />BLOCK <br />TRACT '— <br />DESC. <br />OWNER ADORLSS ZIP PHONE <br />.lam sts a4b8 <br />' R % cm6w _� � �� Avis . N E. 98/oS vy3re <br />TENANT NAME <br />CONTACT NAME PHONE <br />s7E%e ('Jilstfj 195- 75:11^a731.2 <br />CO,N�+TRACTOR ADDRESS <br />/" Flc 6jzs % CvHST /9ort 7EF&-RSwj Am i ZIP CONTR. LICENSE N <br />piK7iUx a HH vN <br />pMON#,U-743 o73%3 Lr�NtJwWo Guk. q$U37 <br />PROPOSED USE OF BUILDING <br />Building I-"1 Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT Combination IFv1( Plumbing <br />TYPE Demolition Sign <br />I <br />(WORK <br />TYPE <br />Alteration <br />New <br />R <br />® Electric <br />Gas <br />Sprinkler <br />Repair/Mainz. <br />B Other <br />CONTRACT PRICE OF WOR </j �Ur , C-,o <br />�rlD <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />I <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />A/C—AIHANDLING UNITS <br />LAVATORY (WASH BASIN) <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />_ <br />METAL FIREPLACE/STOVE <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />_ <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />FLOORDRAIN <br />_ <br />GAS RANGE <br />BACFLOOR <br />PE/BAR/ ER <br />_ <br />GAS PIPING <br />SINK SERVLOW <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 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 <br />CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMA14CE 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 />CONTRACTO 18.27 RCW AND 396.200 WAC. <br />IT'dii <br />Signature o caner/Contractor/Authonzed -Agent Date <br />