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IFCRMIT APPLICATfbN <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. N <br />PERMIT rr <br />rn o are 1 033 <br />5W5 Aid <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHON4,P-,;.— <br />{61el2e7T /1Uc_1v.5TL1A1. ASSlJc S00 /OS AXkt,' 5-r2-y Y'5�7_8Lzr <br />TENANT NAME <br />CONTACT NAME PHONE <br />5ye I2,97 I <br />Cjg kR sf Day yas - y z 2- <br />CONTRACTOR lti���. ADDRESS ZIP CONTR. LICENSE 0 <br />oq -- v7� ✓ltiywA� gGLSTRNooUyTK <br />p0 fox 70 <br />PHONE5%�12 <br />PROPOSED USE OF BUILDING <br />fi Budding FyMechanical <br />Andition <br />MEAT SOURCE <br />PERMIT <br />TYPE <br />IIIU.�j( Combination Alt-v(( Plumbing <br />DPrinkler Sign <br />WORK <br />Allamlion <br />PTYPE New <br />Electnc <br />Gas <br />Sprinkler <br />I <br />RePaud.fa nt <br />Other <br />CONTRACT PRICE OF WORK O� Q Q CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION _ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_ <br />_ <br />_ <br />_ <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />_ <br />_ <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />_ <br />_ <br />_ <br />_ <br />_ <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVIC6'BAR/MOP/ETC.) <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER -- <br />_ <br />_ <br />_ <br />THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />I HEREBY CERTIFY <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 />CONTRACTO S LAW 16 27 ROW AND 296,200 WAC. <br />£ignalu OwneConlate <br />