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ERMIT APPL.ICAT. JN <br />CITY OF 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. k P RMIT N <br />oo�i �� <br />LEGA LOT NO. BLOCK TRACT <br />DESC. 2 <br />OWNER ADDRESS ZIP PHONE <br />G ^�,. Led 415 t;ti 9Ylzo 7oz - �'9 z- 9/tXj <br />AA7- t;c,*,vAj)lid�yjs 330 / <br />TENANT NAME CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />Tn ne fie 1P'Mlae� <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />M Building Mechanical <br />IIIL-`J(`r Combination IIH.�{( Plumbing <br />IJ Sign <br />WORK <br />TYPE <br />I <br />Addition <br />Alteration <br />New <br />HEAT SOURCE <br />„ R Electric <br />i��� {..( Gas <br />TYPE <br />Demolition <br />Sprinkler <br />Repair/Maim. <br />U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />P✓!brf7.K v/1 173oycle 3 J1 Jj qH,r e7i 11#M4/41 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C - A/HANDLINGUNITS <br />FORCED AIR SYSTEMS <br />_ <br />— <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER � <br />_ <br />_ <br />_ <br />HEAT PUMP <br />UNIT HEATERS / ] h <br />DRYER <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES <br />_ <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />WATER HEATER <br />_ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />_ <br />_ <br />METALCNSERT FIREPLACE/STOVE <br />URINAL <br />—FIREPLACE <br />I INSERT <br />— <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />RANGE <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />—GAS <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />_ <br />I -- <br />i <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I I JAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LA'NS AND ORIDINACES GOVERNING THIS TYPE <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />I AM D BY THE <br />TING <br />STATE OR LOCAL LAWOWNER WO K FORCONSTRUION ORIWHICH PPLICAT ONES MADE AND TION. COMPLY WITH THE SOTATE <br />OF THIS PROPERTY OTHAT <br />PEP PERFORM THE <br />11111 CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />ZD 0 Z <br />il,/ { fl S/7 YYNM Date <br />A(gent Date <br />Sig�o�wner/ o r ctor/Auth-o+rize-d <br />1I <br />Z <br />