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PLAMIT APPLICATIC J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SU--.�o 7- 00C, <br />SITE ADDRESS PARCEL TAX I.D. N <br />PER CT <br />b 141' 1V'.5E Ss(" v7�lCiUG <br />I <br />LEGA LOTNO. <br />DESC. f, O CC <br />BLOCK <br />TRACT <br />OWNER ADDRESS ZIP PHONE <br />�` Ll�Cll �(1�e1'�i15e�S ��hcL Kl >i8-h,hl,j(e i' �tol Ir�(2/�( (U✓���0�3 <br />TENANTNAME <br />9/1 dLh�1.8 5�-, <br />CONTACT NAME PHONE <br />C4 C �{1Q5��1hW 1 1 Vr-A/T11(. <br />CONTiiAC70R FZ) f} if D�-eY IfILL iLQ ADDRESS LP CONTR. LICENSE N <br />PHONE <br />I � 1 <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />R <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combinalion Plumbing <br />WORK <br />Alteration <br />Electric <br />TYPE <br />B Demolition Sign <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Mainz. <br />Other <br />CONTRACT PRICE OF WORK, l �/ h'fj"� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />y, ,y <br />WORK DESCRIPTION ��'�ii',')�, ���/-�1�•��Lbl'bl �E�r2C�D -','L{. 1.1 Gil IU �.'�� S :-� �ZCZ % C <br />4o slew n..w <br />I � <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />_ <br />A/C—A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />=DISHWASHER <br />CLOTHES WASHER <br />MET<.L FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />i _ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />j _ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />I_ <br />SINK (SERVICE/BAR!MOP/ETC.) <br />EXHAUST FAN <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 ORIDINAC[3 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT P'IESUME 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 />CONTRA ORS LAW 18. 7 RCW AND 296.200 WAC. <br />— <br />'7j , , �- �- <br />Sigrt ure of Ownor/ComractorUre of /Conlracl0r/AUmW1zed AgentDate <br />