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PERMIT APPLICATI& <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE A D SS Pr�E <br />9 4Yt-. S.F.',,,4- <br />PARCEL TAX I.D. k <br />1T-2f° <br />PERMIT a <br />Oi <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER L yJ f _ L ODRESS ZIP PHON <br />�aJ33y�oz <br />�r 772/T/ s,�. ,09 P� . �� >� . ffle�> <br />TENANT NAME I' <br />I NA-, z ' /�%i/s <br />CONTACT NAME PHONE <br />(z o % T 99 3-�-y % <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building r'1 Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R Combination ILKJ( Plumbing <br />WORK <br />Alteration <br />(� Electric <br />TYPE <br />B Demolition Sign <br />TYPE <br />New <br />B Gas <br />Sprinkler <br />Repair/Mainz. <br />Other <br />CONTRACT PRICE OF WORK 5W ! <br />((JJLL// <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/NS7T,¢0�rF Ste% 67f- /t-°/f" L,=-7%Ek�. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. i TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <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 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 REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFCRM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. � / .0 2 <br />�0 <br />__-- <br />/�'r� Q&U 7 <br />Signature of Owner/Contractor/Authorized Agent Date <br />