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PL AMIT APPLICATIC,J <br />4mrr 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. M PERMIT N <br />/41/� 75�s , SE, 117z - 00-o.2-on Moaoq-oi� <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />ZIP PHONE <br />OWNER <br />/A,//DDRESS <br />TENANT NAME <br />CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />QU,eLiry G�gsr ,l •��/ yBZoy Qve,4 IW-4 08i4 <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />n Building echanical <br />Co!nbinalien Plumbing <br />WORK <br />Addition <br />All, <br />HEAT SOURCE <br />R'Electric <br />Gas <br />1C,ue:_E <br />TYPE <br />IIIu--((j <br />Demolition Sign <br />TYPE <br />New <br />�7 <br />LJ <br />Sprinkler <br />Repair/Ma int <br />Other <br />CONTRACT PRICE OF WORW 4p,G LV Pi <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION _ <br />C' <br />l / --- <br />PLUMBING MEC.HANICAL <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />_L <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />__ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />__ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />— <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />— <br />OTHER — <br />I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />OF WORK WILL. BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE <br />TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME <br />OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEPFORMANCE OF CCNSTRUCTION THAT I AM AUTHORIZED BY THE <br />STATE <br />OWNER OF THIS PROPERTY TO PERFCRM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B"7 R 'N AND-2996200 WAC. <br />�\ Gf��!? 09�2�02 <br />Signature o.' Owner/Con ractor/Aul orleed Agent a <br />