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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.R RMIT 0 <br /> s�99oo/aveo LICOO,5 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC, <br /> OWNER ADDRESS <br /> � <br /> i ZIP PHONE <br /> „ <br /> _ 1Cr- c•nA -DAwac -jA1IZZA-1i 2-7-11 (rt-= Sr -2y1-``5 ) <br /> TENANT NAME <br /> CONTACT NAME PHONE <br /> S3Is32� <br /> yL7�,n,A7n1( �fl Rtr,� 7< - 709 <br /> CONTRACTOR SLC ADDRESS ZIP CONTR.LICENSE 0 <br /> r <br /> PHONE <br /> PROPOSED USE OF BUILDING I Building Mechanical jAldt:ration <br /> AticHEAT SOURCE <br /> PERMIT {R..( Combination IR-( Plumbing WORK Electric <br /> TYPE �] Demolition LJ Sign TYPENew 1a( Gas <br /> U Sprinkler Recair,Malnt. LJ Other <br /> CONTRACT `RICE OF WORK ;SYrfv, — CITY OF EVERETT LOCAL SALE:TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> A-J-o1110 FI <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM LN . 1 TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-AIHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK d DISPOSAL CLOTHES DRYER <br /> DISHWASHER LZ RANGE HOOD <br /> LAUNDRY TRAY Lj- WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN <br /> FLOOR DRAIN _ GAS FIREPLACE <br /> _ 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 TRIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING 1 HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> No r. THE GRANTING OF A PERMIT DOE: NOT PRFDUM"c TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION O 1 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 /> CONTRACCTTORS LAW 18.277*W AND 296.200 WAC. <br /> Signature o wner/ on rector/ ulhorize gent ate <br /> �L <br />