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PERMIT APPLICATILN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET7, WA 98201 <br />425-257-8810 — FAX 425-257-U"857 <br />SITE %DCRESS W PARCEL TAX I.D.N PERMIT N <br />�:,L=7s rS j z.,,T �,d MoaDs--or,Cir <br />T <br />LO- <br />L'iGAt LOT NO. BLOCK TRACT <br />IJESC. <br />AD-JESS ZIP PHONE <br />_%/N9 /lew.�Q1�LWv7, _-z GNIT j <br />TENANT NAME I CONT ACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />SM j7/ vJTR <br />r l c ufT/U Sr <br />C- Y�SM/ <br />PHONE <br />�/t 2Jj 3 :)7A f-VC-2 FS7- t.,,l- <br />PROPOSED USE OF BUILDING <br />Building F-1 MechanlCal <br />I PERMIT Combinalion Plumbing <br />P <br />WORK <br />Addition -IF <br />R Allerelion <br />HEAT SOURCE <br />Q Electric <br />1ylKJ( <br />TYPE Demolition Sign <br />(TYPE <br />B New <br />LJ Gas <br />Sprinkler <br />Repair/Mainl. <br />LUJ Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />Cl�if C F o Lf L 47r!' yEz-, r-7!Z <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />E OR ITEM <br />_ <br />WATER CLOSET <br />7A/HANDLING <br />;—A/C <br />UNITS_BATHTUB <br />STEMS_LAVATORY <br />(WASH BASIN) <br />SHOWER <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />L WATER HEATER (('z J></ c) <br />_ <br />CLOTHES WASHER <br />_ METAL FIREPLACE/STOVE <br />UR114AL <br />DRINKING FOUNTAIN <br />FIRE?LACE INSERT <br />FLOOR DRAIN <br />__ GAS FIREPLACE <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <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 TH'- SAME TO DE 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 <br />CONTRACTORS LAW 1/8.27 WITH THE STATE <br />C/-` RC AN 200 WAC. <br />Signature of ner/Co Q <br />ra tov u orized Agent Date <br />i <br />