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i <br />PERMIT APPLICATION <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 />3s Y1 tAltbl'tar�•4t1e <br />PARCEL TAX I.D. 0 <br />do SI cb74/ a� <br />PERMITS <br />M03 2 c3q <br />LEGA LOT NO. <br />BLOCK TRACT <br />DESC <br />OWNER SS PHONE <br />. R s Lt kE 35-z-y Wctsmw*-p *le- 9',P-zo `W2R 37sc) <br />TENANTNAME <br />CONTACT FOR PERMIT PHONE <br />CgNhct�nl(£Cyur' lDa*W �w <br />CONTRACTOR/ i V (' <br />( ZIP <br />ADD�RfE�SS�,,,,� <br />I `.�� fK�197/4g <br />C� <br />(y��! <br />I (� <br />PROPOSED USE OF BUILDING <br />Bulkling Mechanical <br />AddSPn <br />HEAT SOURCE <br />PERMIT <br />-!PE <br />S I <br />bn umeing <br />B Demolition <br />B molitbr 3lpn <br />WORK <br />TYPE <br />ersSPn <br />New <br />Ne <br />Electric <br />One <br />Sprinkle; <br />RepeklMslnl <br />Other <br />CONTRACT PRICE OF WORK / _ O.7 4 CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />�V�Y14.ce �o, cvo l�u IS <br />PLUMBING <br />MECHANICAL <br />NO, ME OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C - ANDLING UNITS <br />BATHTUB <br />Z <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK S DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <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 />BACKFLOW PREVENTER <br />GAS PIPING <br />S NK(SERVICE/BAR/MOP/ETC.) <br />EXHAUSTFAN <br />OTHER _ <br />OTHER <br />I HEREBY CERTIFY 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 NO- 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 />CONTR TORS LAW, 200 W fC I <br />' 1 �[ <br />1�RCW296 <br />SfZGC � d <br />Slg ur# of Owned on actor/Ault ad Agent Dale <br />I `5-7703 ZJ�8- DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />2'd LS89LS2Sct. - ;W0dJ 8£:80 £002-6T-D30 <br />