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P�RMIT APPLICATI� <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.# PEAMIT a <br /> � -Ih �✓i �,✓. M�wz-�z. <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS ZIP PHONE <br /> ��C��S'� U" 1tC ( �nS�YUG�loh <br /> TENANTNAME CONTACTNAME PHONE <br /> mG� f3r�l� �.2.S- 3Q�- �r7 <br /> CONTRACTORi I�.J�,r� I..�f���<• ADDRESS S()' �qj, S`31 21P CONTR.LICENSEp <br /> �i•it �i / L� �G-+{/I��''J1� �G.� <br /> PHONE �6�_ �Cr�— �CCC` � S7fYr�1S �.I� ��SFl <br /> ��_iJ <br /> PROPOSED USE OF BUILDING f� Building f� Mechanical Addilion HEAT SOURCE <br /> PERMIT �_� Combination ��� Plumbing WORK �Alleration � Electric <br /> TYPE �j Demolition lJ Sign 7YPE New Gas <br /> I.) Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> Ti,s�ll C��� }—G�✓VY�CG 1 �u��z✓or� y �z,s ����p 'n5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB �j� FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER I� GAS P,IPING <br /> SINK(SFRVICE/BAR/MOP/ETC.) I EXHAUST FAN <br /> OTHER _ OTHER_ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND hNOW THE SAME TO 6E TRUE AND CORAECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TH GP.ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF COPJSTRUCT�ON. THAT I AM AUTHORIZED BY THE <br /> OWNE F l�HIS PROPEPN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONT CTORS LAW 1827 RCW AND 200 WAC. <br /> _ / �l <br /> r <br /> Sign r o! nedConlrar.tor/Authorized Agent Date <br />