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PERMIT 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.# P MIT# <br /> 31 60- 'A ST S. E, C20,5971-70000 <br /> 3300 I � LL; -003 <br /> LEGA LOT BLOCK TRACT <br /> DESC. —OCD /'f f 6ffLA-/fly v4C Rb 5 <br /> OWNER ADDRESS ZIP PHONE <br /> 'RIck+AT2D 9.21 aNn ST MuK/(_TEv wA. /fws- ys-26S�iS10 <br /> TENANT NAME CON'ACT FOR PERMIT PHONE <br /> VA-r- #W T r(21CKARb SfELMATS 14z s--Z6S 9S2_0 <br /> CONTRACTOR OWN b R ADDRESS ZIP CONTR.LICENSE# <br /> S.4A <br /> PHONE <br /> PROPOSED USE OF BUILDING RBuildingMecl ,nlcaltaAddition HEATSOURCE <br /> PERMITCombination J Plumng (WORK Alteration I I�'Electric <br /> r <br /> SIM(el. F�.¢MrL-J TYPE Demolition L Sign TYPE New B Gas <br /> /tOM Lc / Sprinkler Repair/Malnt. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE 15 7105 <br /> WORK DESCRIPTION <br /> s}D)D n1Fw 8,4rN)ZvOh-t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM 140. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH 3ASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ 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 GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS:F 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 GrVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME'OERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERT'TO PEI FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LA BCW b 298.200 WAC. r ,/ <br /> J —T� <br /> Signature of caner/ tr ctor Ized Agent Date <br /> DEBIT& CREDIT ;.ARDS ARE NOT ACCEPTED <br />