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PEK.JIIT APPLICATION <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. N <br />7'C � f� s" C- /• >'�= .� 9US/E�C�U _�G.z i <br />LEGA L0T NO. BLOCK TRACT j+�- <br />DESC. ' R <br />� '4 <br />QWNER ADDRESS <br />Wsnd�ll Smtt /ar�rlop, /n�. <br />.tirou Romm�o - Prrsidenl <br />TE {jp) . //�qlh /'lnrt .S.li. I ^ONTACT NAME <br />/:�lYl'ffl. ii�1� yd'2(kJ <br />CONTRACTOH <br />PHONE <br />AODRESS <br />� <br />(��� - / (o <br />I�P,EIPMIT/ M i <br />—J�PD�3 � /Z <br />— iv. 2 I� <br />va s �.z .�:� i� <br />PHnNE <br />� ZIP COA�TR. <br />• . <br />� �,;/g.v�i'SAl• �; <br />M• , <br />�• . <br />�`? C <br />PROPOSED USE OF BUILOING 8uilding f"1 Mechenical �Addi��on HEAT SOURCE <br />PERMI7 Combmalion F� Plumbmg WORK Allarouon n Eleclric <br />',�)� �� ��'�`�� TYPE Domolilian lJ Sign TYPE New {�=(( Gas <br />Sprinkler Repr�r/MuiN. lJ Othar <br />CONTRACT PRICE OF WOqK CITV OF EVERETT LOCAL SALES TAX CGDE IS 3105 <br />WORK DESCRIPTION �•�,�� t 7� ��' ��, J_ <br />N0. I TYPE OF FIXTURE OH ITEM <br />WATER CLOSET <br />�ATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHEH <br />LAUNUNVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN7ER <br />SINK ISERVICEiBAR/MOP/ETC.) <br />OTHER ____ <br />N0. I TYPE OF FU(TURE OR 1Y[!d <br />_� A/C-A/HANDLINGUNITS <br />�_ FORCED AIH �YSTEMS <br />� HEAT PUMP <br />� UNIT HEATERS <br />� CLO7HES DRYEFi <br />1 RANGEHOOD <br />� WATER HEATER <br />� METAL FIREPLACE/STOVE <br />�FIREPLACE INSERT <br />GAS FIREPLACE <br />�T GAS RANuE <br />� GAS PIPING <br />—,Z E%HAUSTFAN <br />OTHER <br />I HEREBV CERIiIFY THAT I HAVE R[AD AND E?CAMWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECI. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WIIL BE COMPLIED WITN WHEI'HER SPECIFIED HEFEIN OR <br />NOT THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITV Tp VIOIATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFCRMANCE OF CONSTRUCTION. THA7 I AM AUTHORI2ED BY THE <br />O\NNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />�ONTRACTORS LAW 1827 qCW AND 296.200 WAC. <br />1 _ , i <br />.1 <br />�IZ <br />