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PERMIT APPLICATION <br />OOL CITY OF EVERETT PERMIT 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 />PERMIT n <br />3 3(aI-1, s+ip"ECi- <br />BD1 I l —bo(p <br />LEGA LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />l..VCiiiC'tf- -Z2.0 l:op7 C- <br />TENANTNAME <br />CONTACT NAME PHONE <br />1Af\'kyn A COY l-v\O( I <br />po F-C C'00g e1;'% zs') - P?)-?9 <br />CONTRACTOR %,U {,AIAC CQ0SI`- 1-r'v, ADDRESS 7%3c(92., (�0It�;e Li ZIP CONTR. LICENSE <br />Mi-,UG'fic 3 13iVLPC63zft <br />PHONE -3 c.( z ;t' <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Building Mechanical <br />tL�K,(j Combination Plumbing <br />WORK <br />Addition <br />Alteration <br />HEAT SOURCE <br />Ele:tric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gain <br />Sprinkler <br />Repair/Mains. <br />Other <br />CONTRACT PRICE OF WORK �/ Q� <br />_f f <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />R00-' 'A%-J0401/\ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />— <br />WATER CLCSET <br />_ <br />A/C — AIHANDLING UNITS <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <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 rOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERWT 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 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date �� <br />