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PgRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />&CLgL4 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />(615 - 5t-�% (;-� <br />--�: � <br />LEGA LOT NO, <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />A,!)1Ie*,t- <br />(Zs3)83a I� <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />Ai iso in B A <br />fl 9-r- SySrC� �n1EST -2 19 FPs fSTAc,r/ E <br />F(/Zt;SV±-I <br />/�RD1 <br />PHONE(2CJ3J\VJA yi—IcrT8 1 A6 FlC 'L1604—T <br />PROPOSED USE OF BUILDING <br />fi <br />PERMIT IIL�—Jj(( <br />Building f'1 Mechanical <br />Combination IIL--J(( Plumbing <br />WORK <br />r. Addition <br />� Alteration <br />HEAT SOURCE <br />Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Mainl. <br />Other <br />CONTRACT PRICE OF WORK [� 3,/_-/ G <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION STIAj6r '1cp7>5 A.p�,yUp AabFo <br />Rr Cf�Al,\gCp, — WSTAw ��) N CAJ ftCAoS pt PF 6i0 e <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C — AIHANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <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 THE SAME TO BE TRUE AND CORhECT. 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 />IWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />.ONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/27 r 6 I c 4 <br />Signature of Owner/(,— o�ct F onzed Agent Uate <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />