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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 <br />132 (e3`� <br />PARCEL TAX I.D. # <br />pERn11T tt <br />;t,sf- <br />003`1911 ooZoo� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />Cho 7 <br />0- - VEP-Ly 1-IIL.5 vIV. Z <br />OWNER <br />ADDRESS ZIP PHONE <br />T(LE(Z oLsoN <br />1c3R° sT• 5E-, `182d3 <br />39e �ss� <br />TENANT NAME <br />�` <br />CONTACT FOR PERMIT PHONE <br />I <br />KSz15TIN 1A4\W�01'-]- 42-5.7-74 `r1z1 <br />CONTRACTOR C� <br />ADDRESS ZIP CON-R. <br />LICENSE # <br />PHONE G1Z5. 3 <br />`I <br />2 ffi <br />� r�3 sr. sF- ev, <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />R <br />Addition <br />HEAT SOURCE <br />5� <br />PERMIT <br />TYPE <br />I <br />Combination Plumbing <br />Demolition D Sign <br />(WORK Alteration <br />TYPE New <br />Electric <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />�Ck� — <br />CITY OF EVERETT LOCAL SALES TAX <br />CODE IS 3105 <br />WORK DESCRIPTION�X 1-5 FAM IL`f Ro0N1 f� n D 1--r4 U lU p R-� R,ODM <br />MAST P, 1\L(�AvTA) FAMaX Roots �ATTAtN•GAleA6je• EMaVfGAt�Mp-T <br />�{ l0'-01 Cfr- MID 0-F K,FAQ CyA0At!5j.V• keLO `jy7. 7�Jw`�`4A�E <br />PLUMBING Ur:ru Aurr Ai �yT'rY <br />NO. I TYPE OF FIXTURE OR ITEM <br />I WATER CLOSET (TOILET) <br />BATHTUB 4— —i/__ <br />1_ LAVATORY (WASH BASIN) _ <br />_ I SHOWER <br />_ KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY ` r <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C—A/"ANDLINGUNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER I <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />\ <br />(� <br />\(\1r <br />\ V <br />_ <br />_ <br />_ <br />Z <br />_ <br />% <br />GAS PIPING <br />EXHAUST FAN /1,/ <br />_ OTHER <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />°ROVISIONS OF LAWS AND ORIDINACES GCVERNING 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 RC%V AND 296.200 WAC. <br />Slgnaturo of Ownevicentractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />I/ <br />