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PERMIT APPLICATION <br />CITY OF EVE�ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 - FAX 425-257-8857 <br />SITE�AD-`DI�$S <br />t i i'"'�`� <br />LEGAL LOT�� ��+ BLL � O� N <br />DESC. •-�` 17Y/1'1f/v <br />PARCEL TAX I.D. A <br />`1Qj05I �I00?jOD 700 <br />Ia� <br />�lC�v U�Mi'�� INv l���� ���vi�w N�� �u�. h��t� <br />TEHANT NMAE <br />hk'a�-��'� w� /�+ � <br />CONTRACTOR <br />CONTACTNAME PHONE /��5\33Ci-5 <br />W� �i2- va N M�+I�>��, n. �. � � <br />ADDRESS <br />21P CONTR. LICENSE R <br />�74�,d-M�GV�l���IG'�i �OFi3�i�AVI�W NW �'�,{.AMI2`��o�''FfJ� <br />PHON�,zo�o��qr.--���8 <�a�-�,� ��ii� <br />PROPOSEU USE OF BUILDING �{ Building f"1 Mechaniral Addition HEAt SOURCE <br />G}�'I�D�'�ykvf�v �iI�IN I(i PERMR �1-{( Combinalion i_� Plumbing WORK �QQ Allorahon Eleqnc <br />I TYPE u �emolition lJ Sign iYPE �..j New �GA9 <br />U Spnnklcr U Rapni�.'MsInL OMor <br />CONTRACT �RICE OF WORK 11 � OOO � OO -� CITV OF EVERETT LOCAL SALES TA% CODE IS 7705 <br />WORKDESCRIPTION-��1' IM��VI�i'M�/NI" Gn�1��K'd/�'�/�GUN�/i �N <br />G�u�,t��� ��,i�aiN�� . �it-�r o� �ve�ett p�N �ol� <br />}t t�atto-a.�fl <br />NO. I 7YPE OF FIXTURE OR ITEM <br />� WATEF �LOSET <br />BATFITUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISIiWASHER <br />LAUNDRV TRAY <br />CLOTHES WASHER <br />URtNAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SER'✓ICE/B!.3/MOP/FTC.) <br />fR�a <br />TY!`E OF FIXTURE OR ITEM <br />AIC - AM1IANDLING 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 INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />1 HEREBY CERIiIFV TMAT 1 HAVE READ AN� E7(AMIN[D THIS APPLICATION AND KNOW THE SAME "f0 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAV�'S AND ORIUINACES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NJT THE GRANTMG OF A PERMIT DOES NOT PRESUME TO GIVE RUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCPL LAW REGULATING CONSTRUCTION OR THE PERI�ORMANCE OF CONSTRUCTION. THAT I AM AtRHORIZED BYTHE <br />OWNER OF TFj15 PRGP F�TY TO P[RFORM THE WORK FOR WHICH APPLICA ION MADE AN01 COMPLY W11H THE STATE <br />CONTRACTO W B P7 RCW AN� 296200 WAC. <br />�� � � �2•(. C / L�� _Z �% � 3 <br />Signalure ol Owner/ConlraciorlAulhonzed Agent Dale <br />��L <br />