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F� `RMIT APPLICAT[A <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 />Mb <br />PARCEL TAX I.D. # <br />PERMIT a <br />c <br />c, %/ ,5`!/C <br />O a je /�{o �2' 6 o /SO o <br />I C'0 3 o.2 -D.Z fa <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />T <br />OWNER ADDRESS ZIP PHON <br />�o yLy' fig -9 hy 43�S S%.4iid �� 3 <br />s-Oi!/ PsTAdG <br />TENANT NAME I <br />CONTACT NAME PHONE <br />RONTRAOTOR ADDRESS ZIP CONTR. LICENSE it <br />boy& A Joi d ,570,/ y/v 3 9 5-14/(cfW� <br />PHONE <br />PROPOSED USE OF SUIL G �/1/� <br />X-- 1',- <br />PERMIT <br />Building f, Mechanical <br />Combination Plumbing <br />WORK <br />Addition <br />Alteration <br />HEAT SOURCE <br />Electric <br />M�}iry) {v( //lyov �'4 <br />TYPE <br />IIL—�J( <br />Demolition Sign <br />TYPE <br />New <br />"Dk7YC. <br />ly Gas <br />_ /ro / 41- /¢ <br />r <br />Sprinkler <br />Repair/Mainl. <br />Other <br />CONTRACT PRICE OF WORN 1 7C 600 & AW <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />° � Q �C <br />m u <br />oZ .sio�y /1-tP�->( � .l fV/� B.tlsc,rrC�Ji _ 3Jvv 5� <br />a�soCe-� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLINGUNITS <br />I17- <br />,7� <br />BATHTUB / / ��� <br />LAVATORY BASIN) <br />FORCED A.A SYSTEMS <br />(WASH / / �. <br />HEAT PUMP <br />SHOWER / // <br />UNIT HEATERS <br />2, <br />KITCHEN SINK 8 DISPOSAL <br />j <br />CLOTHES DRYER <br />DISHWASHER <br />2_ <br />RANGE HOUO <br />_ <br />LAUNDRY TRAY <br />,9 <br />WATER HEATER <br />3 <br />CLOTHESWASHER /// <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />y <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />)W <br />EXHAUST FAN -H-4-L <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 />PROVISIONS OF LAWS .AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COM^LIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE 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 LAW 18.27 RCW AND 296.200 WAC. <br />Signature Owne ontractor/Authorized Agent Dale <br />yz <br />