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WE MIT APPLICATION <br />OrW77- CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257.6810 - FAX 425-257-8857 <br />PE M <br />SITE ADDRESS PARCEL TAX I.D. p IT w <br />3 0 <br />s Z o CPO <br />LEGA LOT NO. BLOCK TRACT <br />DESC. — — <br />OWNER ADDRESS ZIP PHONE <br />60tmcast is- Strut- --':kJ, E �t�, WA q'iwq <br />TENANT NAME C014TACT NAME PHONE <br />(oy^ CAST' 5A%116A MI (I4eX (qz) <br />CONTRACTOR I RESS 1 � {{IP CONTR. LICENSE 0 <br />lJ111tter5al WCAAvIlcal g9AD01 f� (ows �� �tA►uol j WA 9g05t, <br />PHONE_ /{ 91 UNIVFM513L <br />PROPOSED USE OF BUILDING BwldngrMechanical AdnanHEAT SOURCE <br />Combination IIL-`J(( Plumbing WORK lectric <br />[�PERMIT �Aneration <br />G:T Ifni TYPE Demolition Sign T/PE New Gas <br />H <br />Sprinkler RepaiuMart Omer <br />'1 <br />A CONTRACT PRICE OF WORK I11 gvr <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />L r <br />WORK DESCRIPTION iNs�11 1 w3 Vkc�-ICI ��1Tery c>" "I ckii:A 1G vwf-. Wf+A% <br />Zc.ttNOC <br />Q55CW-IN4Yd k/ QIt^i'C15ft J Av.oL f4A rVA&Staf' <br />PLUMBING <br />MECHANICAL <br />NO. TYPL OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A!C - A/HANDLING UNI . S <br />_ <br />BATIITUB <br />FORCED AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK t'• DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRA1 <br />__ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLAC&STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />=_ <br />GAS PIPING <br />_ <br />SINK (SERVIC✓BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER_ <br />__ <br />OTHER- <br />-I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PPOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK'NILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING 7F A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION )F ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF T IS RO, ERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT '' WAND 296200 WAC. <br />Sig ure of wrier/Contraclor/Authorized Agent I Uale <br />L <br />