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-- — t. <br />PERMIT APPLICATION <br />OL CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425.257.8810 - FAX 425-257-8857 <br />�52-\�5 '72E f"T s w <br />SITE ADDRESS <br />PARCEL TAX I.D. 0 <br />PERMIT 0 <br />!/l-oe/-oo,-oo <br />ry)DAI0-D0, <br />I <br />LEGAL LOT NO. <br />BLOCK <br />TRACT 5,11 r1/AISP Z$ TA,VlE ¢ <br />DESC..6 of �} <br />eDtD/ c <br />F Zo z - <br />OWNER ADDRESS ZIP PHONE <br />4Ter <br />TENANT NAME <br />CONTACT NAME PHONE <br />AA 111VI✓iac�L MAC . 1CA-'— <br />I 8%0/ WILLDk/S /20 9ktli tJNIVC S/12JF <br />CONTRACTOR ADDRESS /pZ.�L.DMOAJIN ZIP CONTR. LICENSE <br />pp�� <br />PHONE 4L.S'Sp�J -O6 fZs BS/-G 4��7 /CAK <br />PROPOSED USE OF BUILDING <br />Building <br />AddNon <br />MEAT SOURCE <br />PERMIT' COmbinalion Plumbm0 <br />frechanic31 <br />WORK <br />n Electric <br />i!/C/O <br />LrFJSj <br />TYPE Demolition Sign <br />I N Sprinkler <br />TYPE <br />I <br />gA,,,;,,,, <br />New <br />Repair M,,-r <br />E Gas <br />Olher <br />CONTRACT PRICE OF WORK Z�/_Q r CITY OF EVERETT LOCAL SALES TAX CODE IS 3195 <br />WORK DESCRIPTION (!! v <br />IN5741-L- 5_501i 0iF,C0S6/t-S �y RFrl-4A) G12�r�s <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK S DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/610PIETC.) <br />OTHER_ <br />_ <br />A/C - A/HANDLING UNITS <br />FOR1,ED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER QliialrL f 6R/cL rWA-L <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY 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 AUTHORII : TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 1NE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACIeSdAW. I BZJ-RCW AND 296.200 WAC. <br />