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.- - <br /> : <br /> . <br /> PERIVIIT APPLiCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-E1857 <br /> SITE�GRE\S^ �� � _,P� C�L TAX I.D.q PE � � <br /> _ v� \ <br /> LEGA LOT NO. BLOCK THACT <br /> DESC. � �� L,qC,h� (3e.7Ut� CSTifT'ES <br /> OWNER qDOR[SS ZIP PHONE <br /> CO�� I��-Cl.�IIIJ (,,, � � `�1 �� �If�Vl2 JI�R.Ir1llS �/I1y� �.Jr�.SWW�J C.� rt,. / VZIZ► I <br /> TENANT NAME CONTACT NAME Cy tS� FA� PHONE C`u i <br /> N/!''. I DA�cC�2f6[�c.G 33y -S435, 339 -593G � 330-,Z�JL(o I <br /> COIJTRACTOR ADDRESS 21P CONTR.LICENSE# I <br /> PHONE GOI.00�l �03eJN� I <br /> SAM--C �xP. � o/yz,'a3 I <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> � . � 0 � PERMIT � Combination � Plumbing WORK � Alteration I� Eleciric I <br /> TYPE Demolilion U Sign TYPE New � Gas <br /> � Sprinkler(B cl heatls) RepaidMeint. V Other � <br /> CONTRACT PRICE OF WORK CITY OF EVERFTT LOCAL SALES TAX CODE IS 3105 II <br /> WOFiK Df�SCRIPTiON I <br /> (���a,a 1�'� �( U <br /> (°.�E-� �,� a_ � � �, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Z WATER CI OSET(TOILET) _ A/C—A/HANDLING UNITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> � LAVATORY (V�ASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> I KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER I RANGE HOOD <br /> LAUNDRYTRAY I WATER HEATER <br /> � CLOTHES WASHER METAL FIrIEPLACE/STOVE <br /> I = URINAL FIREPLACE INSERT I <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOF DRAIN I GAS RANGE ' <br /> _ BACKFLOW PHEVENTER � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPlETC.) � EXHAUST FAN <br /> _ OTHER _ OTHER_ OZ <br /> f��� <br /> _ _ C�r <br /> ��� <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PHOVISIOPIS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAIJTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTF,UCTIO�. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RC A D 296200 WAC. <br /> ;/ � /� <br /> ���='_J- f� ,c,/(�/. ��lU /03 � <br /> Signature of OwnedContractodAuthorized Agent Date ^\ <br /> I %iZ <br /> I <br />