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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7 ;EET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS, <br />goy vo CAsT. Sw <br />LEGA LOT NO. BLOCK <br />PARCLL TAX I.D. # <br />cv y( u3 oaw 10000 <br />TRACT <br />PERMIT R <br />kv vN- oo 2 <br />CIF MUM: <br />��-Sandf� (-prnrrl � `looT� � sZ1�� ,t/6 lac;/ gsmiz. <br />TENANT NAME / CONTACT FOR PERMIT PI/ONE <br />Fa G, lc- T-01,50 r l S I (drat CQ ZLg -7 Z ti -OQ vc <br />CONTRACTORRt7i �o,(tkRtcr SNrpr�p ADDRESS <br />!prop r 24b v 9 ZIP CONTR. LICENSE it <br />PHONE <br />rf r. <br />Sect.T e (,-4, <br />zo6-rr Z6 -D 4 Ufa <br />/ <br />PROPOSED USE OF BUILDING I <br />PERMIT R <br />Building Mechanloal Addition HEATS )URGE <br />Combination Plumbing Alteratlon Elcrtnc <br />TYPE B <br />(WORK P <br />Demolition Sign TYPE New Gas <br />Sprinkler Repair/Maim. Other <br />CONTRACT PRICEPRICE OF WOR <br />CITY OF EVERETT LOCAL SALES TAX CODE IS .105 <br />WORK DESC7R1PTIO14 <br />Of Ff/e S%s%r1 <br />/11 lT+is /OiCAM1%`��'"1 <br />��6failckTiofl <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A C - A'HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />ORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />SHOW <br />UNITHEAIERS <br />KITCHEN SINK 8 DISPOSAI. <br />_ <br />CLOTHES DRYER <br />DIO'IWASHERNO <br />-'ANGE HOOC <br />L4_,T RY TRAY <br />__ <br />VvmTER HEA(ER <br />— <br />CLOHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER_ <br />7- <br />EXHAUST FAN <br />OTHERZ"-��J''7/Pr) of <br />eh5Y <br />'HERE Y 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 <br />TYPE OF WORK WILL BE COMPLIED'WITH WHETHER SPECIFIEC HEREIN C R <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME <br />TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />PROVISION OF ANY OTHER <br />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 />CONTRACTORS LAW 16.27 RC NO 296.200 WAC. <br />S55"" ce-- i1f1, #-% <br />jy/j l /a 5 <br />Signature of Owner/Contractor/Authorized Agent <br />Date <br />tl <br />DEBIT & CREDIT <br />CARDS ARE NOT ACCEPTED <br />