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pERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEI', EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS <br />y� 5 5� �s� � �..v <br />LEGAL LOT NO. BLQCK <br />DESC. <br />PARCEL TAX I.D. # <br />'�-`'t b �3t�o c, �i o �33 0� <br />PERMIT # <br />� 3�0 -o� 3 <br />OWNER f ADDRESS 'PHONE <br />�C�c�o.o��--< �S�",�� cw�: �.. i Uc � S 5� sX .�? '�u� i a�✓n -�-s <br />TENANT NAME <br />CONTRACTOR <br />�'aEiiE(�5c.,1 C`ci�tST� /n/C <br />PHONE .i_ _ -.�. �., <br />PROPOSED USE OF BUILDItJG <br />Sfn�i,Cr �ILN <br />.� / <br />CONTRACT PRICE OF WORK <br />N E /i <br />��t'�-�. 1 <br />_. nti-� C� <br />� <br />ADDRQE�SS � <br />�• Q aGR 3005 <br />���� W�1 <br />,P,n a <br />PHONE <br />.�5��' 3 r Cu / <br />CONTR. LICENSE # <br />r.t.��$o q � mE <br />j� Building D Mechanical Addition <br />PERMIT j$� Combination �j Plumbing WORK � Alteration <br />TYPE D Demolition �� Sign TYPE New <br />�, Sprinkler Repair/Maint. <br />WORKDESCRIPTION ,Q��.t.�p� �r �qS— ,•j., <br />ri _UJ <br />I <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDFiY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENiER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />HEAT SOURCE <br />�Eleciric <br />Gas <br />Other <br />CITY OF EVEREff LOCAL SALES TAX CODE IS 3105 <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL F�REPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />� EXHAUST FAN <br />OTHER <br />� <br />I HEREBY CEFITIFY THAT I HAVE iiFAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WII.L BE COMPLIEU WITH WHETHER SPEC�FIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE,4ND 1 COMPLY WITFi THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />Signalure of OwnedConlractodAuthonzed Agent Date <br />