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PERMIT APPLICATI&N <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 />44 <br />ARCEL TAX I.D. 0 <br />PERyJT N <br /><3 I ev <br />G#��S I�dASDIZ Du <br />S4 —5 <br />_- <br />LEGAL LOT NO. BLOCK TRACT <br />DESC.� <br />OWN R ADDRESS ZIP PHONE 17Q(j� <br />CI�Lh u ll)� a l�/7 Sf'i�� fed Lk rr�s ow Ites8 b50 b <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />ZIP CONTR. LICENSE R <br />CONTRACTOR /_�Q,�,� �lZV �DORESS ��/ijt)�� <br />/ps` <br />PHONE n W,4 LIY,,, <br />s/' JI.I.YLLI� <br />3�0'IS�-U9 33 /D l' � _ <br />'ROPOSED USE OF BUILDING <br />PERMIT <br />Building fl Mechanical <br />Combination ILHJ� Plumbing <br />I� Addition <br />WOP.K Alteration <br />HEAT SOURCE <br />ElectricDemolition <br />TYPE <br />Sign <br />p <br />TYPE New <br />�KS((( <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Umer <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTIONyy <br />,e s <br />J, U <br />^���» <br />`_^ <br />%S,1`11 -nQoa fl tHY�� y%i t�Gtl <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />I AUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STCVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOF DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (:iERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST Fi,N <br />OTHER <br />OTHE7 <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 WIT4 WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOPITY 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 />CONT L6,W 16.21 RCN AND 296.200 WAC. <br />4I /o-is-�'� <br />Signature o. Owner/Contract r/Authonzed Agent Gate <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />