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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 />PARCEL TAX I.D. # PERM 'f a <br />4d3o5-o03 <br />LEGA LOT NO. <br />BI OCK <br />TRACT <br />D[SC. <br />OWNER ADDRESS 21P PHONE <br />-0r2L,e F; oh 7SrLJd-2z 619fr2-o,.31 <br />TENANT NAME I <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS CONTR. LICENSE p <br />L l/709 cYi,J <br />ga'e)r <br />PHONE SY Cf///r/wnft-, o,}A'n660T <br />-aiS"c'4{NLp� Nar-fJo-�oz6 <br />PROPOSED USE OF BUILDING <br />MOChanIC81AdditionHEAT <br />SOURCE <br />PERMITPlumbingWORKAlteraElectric <br />TYPE <br />7COmbin'stion <br />m0lillonSignTYPENewas <br />rinkler <br />Repair /Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />`1S,r�00 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION � <br />/ c,04,/- .41..e- da..., c y � •/ o l hr�//���, , (: ` �ni�.,a./ rF�h<� <br />rt:nJ.,lHrt'pep/<,ef rr„v" <br />PLUMBING <br />MECHANICAL <br />NO. TYRE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER LOSET (TOILET) <br />A/C-A/HANDLING UNITS <br />BATHTUBC <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />[DISHWASHER <br />HOOD <br />LAUNDRY TRAY <br />_RANGE <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT j �25 <br />DRINKING FOUNTAIN <br />_GAS <br />� <br />FIREPLACE <br />SO <br />FLOOR DRAIN <br />GAS RANGE 9 <br />BACKFLOW PREVENTER <br />._ <br />GAS PIPING - "--" <br />SINK (SERVICEiBARIMOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFV 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 LOCAI. LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 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 16.27 RCW AND 296.200 WAC. <br />Signature o 0 enConlractonAuthonzed <br />PERMIT <br />Agent <br />