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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS { <br />PARCEL TAX I.D. M <br />PERMIT # <br />" <br />n � <br />C - <br />LEGAL <br />DESC. <br />LOT NO. <br />1 Avg <br />BLOCK <br />TRACT <br />S/ A17 O <br />OWNER I ADDRESS <br />PHONE L/}.S- <br />! <br />572/ �4 G/c uuaa� �v� <br />CRY Az�s�s <br />7+7- 96PP <br />TENANT NAME CONTACT NAME <br />PHONE <br />� <br />ti� , - 716 5- <br />TOR D�d�r c7d NA6S�V L'dI1S11 j ADDRESS CONTn. LICENSE # <br />L-)0(,rr4� cs PP <br />z <br />PHONE '•?'02 7i <br />yLs- 7ys- 2Fi3�_ I <br />PROPOSED USE OF BUILDING Building n Mechanical Addition HEAT SOURCE <br />Q Electric <br />PiERMIT Combination Plumbing WORK Alteration <br />D® Gas <br />TYPE Demolition Sign TYPE New <br />I�{ jQ <br />Sprinkler Repeir[Maint. Other <br />CONTRACT PRICE OF WORK %/ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION f d w <br />NC.u"ddvsi <br />, <br />I PL MBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />i <br />I <br />WATER CLOSET %/f <br />BATHTUB ii <br />LAVATORY (WASH BASIN) )IN ! I - <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />i <br />SHOWER Il ( <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL T <br />CLOTHES DRYER <br />/ <br />DISHWASHER L <br />RANGE HOOD <br />1_ <br />LAUNDRY TRAY <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />CLOTHES WASHER <br />FIREPLACE INSERT <br />6 <br />URINAL <br />DRINKING FOUNTA!N <br />GAS FIREPLACE / <br />_ <br />I <br />FLOOR DRAIN <br />BACKFLOWPREVENTER <br />' 7 f <br />GAS RANGE <br />GAS PIPING;1 <br />EXHAUST FAN n7(lI' <br />SINK (SERVICE/BAR/MOP/ETC.) <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 />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES ON OF ANY ER <br />AUTHORITY C EL THE O <br />GRANTINGNOT. <br />THE UORI EH D BY E <br />CONSTRUCTION. THAT AM AUTHORIZED <br />STTATE OR LOCAL LAW R GULATIP G CONS RUCT ON OR THHE PERFORMAN E OF CO SCO TR T <br />OWNER OF THIS PROPERTY TO ?ERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO LA 18.27 RCW AND 296.200 WAC. <br />Z <br />L�2 <br />Signa re o er ontractor/Authorized Agent to <br />