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PERMIT APPLICATIdN <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.p Pf RMIT p <br /> 1 ' - 5 0 olooao�000 -017 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. I �.� G I arg L.1.5 & i), <br /> OWNER ADDRESS ZIP PHONE <br /> A a2 Fn1eq-Puise�s l.l.c 1-1a-L- 5 AUe2) 113bta Vas 'IWC,-L18 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> 1.-"w1 \-e-n>sk!n 1.4a5- rigs- 111$ <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> AdlauriEVoAs>gvsses 1-7b-3a- AuySE Qtb1a ADI�TR� �o3a 1 <br /> PHONE <br /> PROPOSED USE OF BUILDING uflding echanlcal AtldlOon HEAT SOURCE <br /> PERMIT fonbinallon IrL�y�'�,�,';llumbing WORK LRS Alteration [� Electric <br /> TYPE emolition I� Sign TYPE Ly�New �-Gaeprinkler LJ Repalr/Malnt. l) Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> New g tr-,ale- -� an��\� riZe-s�aczv�t- �o.�P�c. al I a A <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1 WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB _J_ FORCED AIR SYSTEMS <br /> q LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ I KITCHEN SINK&DISPOSAL _L CLOTHES DRYER <br /> I 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 I GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> -- <br /> I HEREBY CERTIFY 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 A'.'THORITY 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 FCR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Sipnatur of Owner/Gontract",/AT <br /> onzed Agent Uate <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED IZ <br />