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f-)ERMIT APPLICA10N <br />CITY OF EVERETT PERMIT SERVICES <br />�j200 CEDAR STREET, EVERETT, WA 98201 <br />425-25'-8810 - FAX 425.257-8857 <br />SITE ADDRESS IL.C-N'r TCf,HNDLobL PARCEL TAX I.D. II PERMIT <br />5� Si- I } ooy ODLEGAT <br />_f"rONO. BLOCK <br />TRACT <br />DESC <br />OWNER <br />ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT NAME PHONE <br />DPo1D Fo7L raf�3-833-Iz <br />CONTRACTOR Fimu gySTE '15 WI ADDRESS Zlc( F.QpNT?.lClr (Z,*o ZIP rONTR. LICENSE # <br />NoQrLd, s�LTt R F12eswr-4 °0 <br />PHONE Z5'3-S"S3-1?-48 <br />Ppt,LFLL, l✓A- <br />PROPOSED USE OF BUILDING <br />Building f"1 Mrchanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R Combir?ation IIL--I(t Plwnolny <br />WORK <br />Alleralion <br />j� Electric <br />TYPE <br />B Demolition Sign <br />TYPE <br />I <br />New <br />B Gas <br />Sprinkler <br />Repair/Mamt. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESLRIPTION <br />Jr7�f ��(uU�iE <br />PPL� �Pr.-/Nr,LWQ-5 f02 #law TUrre+-rr <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLING 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 />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER HEATER ` <br />METAL FIREPLACE'STOVE 1 J�hi(t `�Iry'V <br />= <br />URINAL <br />FIREPLACE INSERT IlU'V1 <br />DRINKING FOUNTAIN <br />GAS FIREPLACE n <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK ISERVICE,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 />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] AM AUTHORIZED BY THE <br />"ER OF THIS PROPE TO PERFORM THE WORK FOR WHICH APPLICATION IS LtADE AND I COMPLY WITH THE STATE <br />RACTORB LAW t 27 R W AND 296.2C0 WAG. <br />y- ai%_ C� 5o2s 3_ <br />Signal wne r ntract rAulhonzed Agent Dal <br />'I2: <br />