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PERMIT APPLICATIA <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 />1b <br />PARCEL TAX I.D. N <br />PERMIT ^1I <br />n <br />�dDC1!-0` <br />A� LOW(-` <br />BLOCK <br />TRACTO <br />DESC. '1 _ �_ <br />326 <br />OWNER ADDRESS 113z-I H1.` O 5E ZIP PHONG <br />G�QL <br />TENANTNAME <br />CONTACT NAME PHONE <br />Hliw* 1125 290-242-q <br />CONTRACTOR ADDRESS CONTR.LICENSEN <br />HAP K SQ07fH£KS Cc1Ns-T- 39L2 <br />(�r�P <br />PHONE — <br />EVERETT 1v2V5- <br />iaA�CKQxv(20Z <br />PROPOSED USE OF BUILD;NG <br />Building D Mechanical <br />R <br />Addition <br />HEAT SOURCE <br />bv��leX <br />PERMIT <br />TYPE <br />I <br />Combination U Plumbing <br />B Demolition U Sign <br />(WORK <br />TYPE <br />Alteration <br />New <br />Electric <br />Gas <br />Sprinkler <br />Repair/Mainz. <br />}IY�O <br />V Other <br />CONTRACT PRICE OF WORK `CA (p r 000 �� p�1 <br />�i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION p <br />Ne„J <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 — A/HANDLING UNITS <br />FORCED <br />LAVATORY (WASH BASIN) <br />AIR SYSTEMS <br />HEAT PUMP <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />_� <br />� <br />WATER HEATER <br />URINAL <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />_ <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />— <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />B_ <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 GR'E AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEF FORMAN.:E OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />ONTRACT LAW 18.27 CW AND 296. 0 WAC. <br />q- t� -oZ <br />gnaWr of Owner ontra t 'zed gent Date <br />(Il <br />