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P6MIT APPLICATION <br />CITY OF EVERETTPERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PPRMIT # <br />L} j 1i8 ►2•x K4si2 Ak:7 <br />009967,0 I to I I oo <br />",\, �C '"CC% <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />54�P'Y Inc. IIZ� IZgr",4vi5:-.nl4F. 6<tLe"�-,yJf} 9Soc.Y5 2Z52 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />$r= C 0 <br />SN,�w�A-1 2>�KI'4-71 ?e611Z2 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />2?3a Ol'L F Da�J24L •4Uc. S . <br />PHONE Zo6Z2''� 1�2. 5�•• 11Ic ..IA�gJ(y>d Tjg4;;;�AD1k311QS <br />-T``````'��'���� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />mkileallon R Plumb ng al <br />� Combination <br />WORKAOPratlnaint. <br />HEAT SEIectric <br />TYPE <br />Demolition �$Ign <br />TYPE New <br />Gas <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />INs-v--�t.L (4) S� rf � t✓-cc-S . oN sT1/0 y <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C -A/HANDLING UNITS <br />_ <br />BATHTUB <br />_FORCED <br />AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />_HEAT <br />PUMP <br />SHOWER <br />_UNIT <br />HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISHWASHER <br />_RANGE <br />HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_METAL <br />FIREPLACE/STOVE <br />_ <br />URINAL <br />_FIREPLACE <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_EXHAUST <br />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 />PROVISIO"S OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING 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 LP JJ 18.27 RCW AND 298.200 W'AC. <br />Signature of er/Co ctor/Authorized Agent Date <br />DEBIT S CREDIT CARDS ARE NOT ACCEPTED <br />