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� .,ERMIT APPLICM�ON <br />MIT SERVICES <br />CITY OF EVERETT tERRETT, <br />3200 CEDAR STREET, WA 98201 <br />425-257-8810 -FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT x <br />q12f� I9-�c ice- Alj.= <br />57'3Zlo <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />v'"`cp�rc�tc�cfl94S`t <br />INC. ►'3�1 cH.vcrv.» 6L-VD. sTe•2.., <br />TENANT NAME <br />CONTACT NAME PHONE <br />6�Gy I <br />S(Mvrrj ZoGz2�i ��Z2- <br />CONTRACTOR i ADDRESS ZIP CONTR. LICENSE <br />'�J�y.�pj2 G�c1,Dr/��+-wL AQ11�.5. <br />p ,�t� <br />PHONEZ�ZZI IIZZ 1��� �, Vc /�U 4E'�I(Q5 <br />PROPOSED i USE OF BUILDING <br />IT <br />Bu.Iding <br />R Nlbig al <br />CombinationP9nn <br />IK <br />tl� <br />I HEATSOURCE <br />Electric <br />Demolition <br />ie <br />�E�Pr <br />I�LU8((3705 <br />ai/Maint. <br />Other <br />CONTRACT PRICE OF WORK 1, eoo <br />CITY OF EVERETT LOCAL SALES TAX CODE <br />WORK DESCRIPTION <br />INw"'C.C.. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR REM <br />_ <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />_UNIT <br />HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <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 />GAS PIPING <br />_ <br />SINK (SERVICEiBAR/MOP/ETC.) <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 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 />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />ner oniractorlAuthorized Agent ate <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED t�L <br />