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PERMIT APPLICAI'ION <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 />��S 33R' s <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />`lvo� (� � crer <br />TENANT NAME <br />Nf�) <br />CONTRACTOR <br />(,J ES CO <br />PHONEa� fo - 1 t 1-ti�{-vD <br />PARCEL TAX I.D. N <br />� <br />� I S 33'`° rk <br />CONTACTNAME p� <br />�a�ice -�iviiaS�`�� <br />ADDRESS <br />aXC�� `I�or..o4�,iLit- 14`�' <br />� ti �-Q� p�i 9 y , <br />PERMIT A <br />h� 0/10�� <br />4� S- 319 - o z�3 <br />PHONE <br />Zo 6 - isl -`1'}ou <br />CONTR. LICENSE r <br />W �} SfF��S 59{6�`^� <br />PROPOSED USE OF BUILDINCi Building ryQ Mechanical ndditlon HEAT SOURCE <br />PERMIT BCombinatlon ��) Plumbing WORK NtereUon Q E�ecircc <br />S� R TYPE B Demolitfon D s�9� nPE New i9 6as <br />Sprinkler RepaidMaint. �� 01her <br />CONTRACT PRICE OF WORK 1r p� O OU �� C!TV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />-�� �..,� rCU� odu (3<`'t C��s �" C,"r FK...te�,o <br />NO. I TYPE OF fl%TURE OR ITEM <br />WATER CIOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />_ LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I 7YPE OF FIXTURE OR REM <br />A/C - fUHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACFJSTOVE <br />FIREPLACE INSERT <br />QAS FIREPLACE <br />GAS RANGE <br />(3AS PIPINCi <br />EXHAUST FAN <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 ORIDINACES GOVEFNIN� THIS TYPE OF WORK WILL BE COMPLIED WITH WMETHER 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 AUTMORIZED BY THE <br />QWNER 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 />� _ — �� ^s-Fi � ` + i <br />