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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 p_b <br />PARCEL TAX I.D. # <br />PERMIT p <br />alloAp lo3 - ST ` <br />00Cygggo040os-u17 <br />I CU30+6al <br />LEGAL LOT NO. <br />BLOCK <br />ACT <br />DESC. <br />r�xs iv <br />UWNER ADDRESS ZIP PHONE <br />nn <br />,Ay't'6 MAC(, oZla U, (o3+�' ST SE �V�'2 ��- g82A 3 LI2�' 3 1�q6 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />-zmo <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />K-FoUQ Coe -.sr. (-y; R 6e_ 10V\ 1CVuwAA'b'AI �(R�o�e�Ip <br />PHONZw)106.p'X00 SN�4.0M�S�. UJA IOZ 1�� o��LC2otocoPP <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />AddlOon <br />HEAT SOURCE <br />\ kA <br />PERMIT <br />TYPE <br />Combination Ifki1 Plumbig n <br />Demolition L) Sign <br />WORK <br />TYPE <br />Alteration <br />New <br />® Electric <br />L� Gas <br />Ce°�j ? l — � l <br />Sprinkler <br />Repair/Maint. <br />UUj Other <br />� we& <br />CONTRACT PRICE OF WORK ) a1 ci <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION <br />�J�u—' ��o—��t CUOM ` R-"-A0&;'keC0 <br />j <br />11 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />/ <br />WATER CLOSET (TOILET) <br />A/C — AIHANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />2 <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />I <br />SHOWER <br />_ <br />UNIT HEATERS <br />I <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />I <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />= <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVI= <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />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 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 1 7 RCW AND 293.200 WAC. <br />Signature o�F�Fwne /Lontrac r/Aoilhorizecl Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />