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PERMIT APPLICAI iON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS I PARCEL TAX I.D.# PERMIT p <br /> -13�- <br /> 7\5T 1 -�R o I-Abi ubrxo► tiao <br /> LEGAL LOT NO. BLOCK TRACT Q5 <br /> V <br /> DESC. I k ` <br /> OWNER ADDRESS ZIP PHONE <br /> 4A(;/ �i4 1-11)1$'1 3s ti- Of"I S;� I/ LA, ` Lf!Z Ll 2s• - 7L/3 )7/1/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> L-It-1 L12f • 7`lf- 171 �i <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE If <br /> I'L:, 5o ."I j4-z <br /> PHONE <br /> LI '-5 jL/ 3 I tib, 'rcloc311 <br /> PROPOSED USE OF BUILDING BuildingMechanical Addition BEAT SOURCE <br /> PERMIT 1 .Combination fh��?(-Plumbing WORK IR( Alteration i�I_ p TYPE Demolition U Sign TYPE JQ New Gas <br /> I\ LLL Sprinkler U Repair/Mainz. I Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> Coc) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) Cr_ A/C—A/HANDLING UNITS <br /> BATHTUB J FORCED AIR SYSTEMS <br /> i, LAVATORY(WASH BASIN) S _ HEAT PUMP <br /> n SHOWER UNIT HEATERS <br /> = KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> I DISHWASHER I RANGE HOOD <br /> o LAUNDRY TRAY WATER HEATFR <br /> 1 CLOTHES WASHER 0 METAL FIREPLACE/STOVE <br /> U URINAL FIREPLACE INSERT <br /> U DRINKING FOUNTAIN GAS FIREPLACE <br /> U FLOOR DRAIN GAS RANGE <br /> BAC.<FLOW PREVENTER o GAS PIPING <br /> O SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> 9 <br /> I HEREBY CERITIFY THAT 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 OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE 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 /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> 111yutf 11111-03 <br /> bignaturO of Owner/ConlractonAuthonzed Agent Dale <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />