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Z.. PERMIT APPLICATION <br />CITY QF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. M <br />g- � /1 PERMIT II <br />0 V}d/ x 4� 3 d oD- 0 3d 3c <br />LEGA LOT NO. BLOCK TRACT n� 1 <br />OWNERS?l1 — U3Z S �Vereff S 1Si <br />ADDRESS ZIP PHONE <br />ry , NeL n ? o. 13d.r 79 &*.0 9 0� vzs-) z <br />TENANT NAME �-�y� _ !CI a �.�� L I CONTACT NAME <br />i- - r,r J ) nn r PHONE <br />( <br />kCONTRACTOR ADDRESSWv <br />�I� MC � �' y / DP CONTR. LICENSE M <br />PHONE [�i�l�lvarr C6»s Z1117 Lo'C/Us(" WaY 9,j?430 KA*At.cWo77DA1 <br />/717,- _ —10 On ! j*,2e 1^T I , , .... , _ n . . . <br />PROPOSED USE OF BUILDING <br />I I� <br />.W <br />Building <br />PERMIT N Combination <br />v <br />Mach nice[ Addition <br />Plumbing WORK Altera,�on <br />HEAT SOURCE <br />f") Electric <br />TYPE Demolition <br />Sign TYPE New <br />ILHl( Gas <br />Sprinkler (N of heads) Repatr/Maint <br />Other <br />CONTRACT PRICE OF WORK up <br />.� 7G/Wo elf. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310S <br />WORK nFRCRIDT1nM <br />r_r—c> r C WL KCX711' T*uT'\ 1 <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACFLOOR DRAIN <br />SINK SERVLOW PE/BARI O <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />— <br />_ <br />I HEREBY CERITIFY THAT 1 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 NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW PECULATING CO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERF01M THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 BOW-ANIY2Cj5.200 WAC. <br />I <br />/ —Z(-O2 <br />