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PLiRMIT APPLICATIC.J <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. H PERMIT a <br />30)o x / S7: I >U Asa o.s 18oac)9-0a- I <br />LEGA LOT NO. I BLOCK TRACT <br />/.1 A74 JI` S (L.%-12 -Q-20 -,Y2q <br />TENANT NAM I CONTACT NAME PHONE <br />CONTRACTOR rr /� ADDRESS ZIP CONTR. LICENSE N <br />S!� Cv�uS�2uc(iu� CovzS 70-6ZI� S1RCv+*-of.GoT <br />PHONE <br />yes- 3/S-C 7y,Y //70(F Cvaus Aul-IL 5�J�;7s <br />PROPOSED USE OF BUILDING R Building Mechanical I Addition HEAT SOURCE <br />PERMIT Combination IR_( Plumbing WORK NAlteration Q Elec.ric <br />TYPE Demolition u Sign (TYPE New I LJ Gas <br />Sprinkler Repair/Mains, U Other <br />CONTRACT PRICE OF WORK c>2.Z o(JD I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />woPX T,zr ss�r + ID <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />SINK (SERVICE/BAR/ OP/ETC.) <br />OTHER - <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 INSE <br />GAS FIREPLAC <br />GAS RANGE <br />GAS PIPIN <br />EXHAUS AN <br />OTHER - <br />_ <br />— <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY'HAT 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 C" WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV.-_ 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 />CONTR WRSJ-IyV,0. , 7 RCW AND 296.200 WAC. <br />)ale <br />