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P113MIT APPLICATIC .I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425.257.8610 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. M PERMIT 0 <br />fv� 72^� si St=410,� 000 oil oo <br />LEGAL LOT NO. BLOCK TRACT ' 1-1, 7 ) <br />DESC. �d (;-v 11 D GAF. -I CTA UC <br />i <br />--tc1,A") 1 (Itvr I''ir yL"i 7-2n.i ST- 5E CJfr<-� <br />TENANT NAME I CONTACT NAME <br />CONTRACTOR <br />PHONE <br />ADDRESS <br />ZIP <br />if1u3 I1 -;t S 7/J'q/7 <br />PHONE <br />ZIP CONTR. LICENSE w <br />PROPOSED USE OF BUILDING <br />Budding <br />f-1 Mechanical <br />Add Pion <br />HEAT SOURCE <br />PERMIT <br />R <br />Combination <br />I{L--J(( Plumhing <br />WORK <br />R Alteration <br />Electric <br />TYPE <br />B <br />Demolition <br />Sign <br />TYPE <br />New <br />Gas <br />L <br />Sprinkler <br />`j�� <br />RPpavMeint <br />Other <br />CONTRACT PRICE OF WORN ; I x / 0 x /(r 1 <br />/,, i`�Q 3 <br />CITY OF EVERETT LOCAL SALES TAX <br />CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />RATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />"FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />A/C - A HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW 1HE 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 IB.27 RCW AND 296200 WAC. <br />.n - - / <br />F 7S O1 <br />C�2- <br />