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- - - -C 4,eA4 u1Fe-q— chi. OdW <br />PERMIT APPLICATION tno6a Io"3e4 <br />CITY OF EVERETT PERMIT SERVICES j &4 icW 221:43 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8310 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT a <br />I S'2(9 93 to6-4c(- S , 0 -L Co tips <br />LEGALrI LOT NO. BLOCK TRACT <br />DESC <br />OWNER ✓ ADDRESS ZIP PHONE <br />CmT 40"C�arWe"L, /nlc-po6oX/571 A.)dir/d.�3i. U14 g00zII (.4zr)3.i 3-/Fud0 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CR►176 a (�ta� �Y) :3 (000 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE e <br />G M-T- J-A • ( AS A&d t)i- <br />P NE f e !JSrid '�iiOeSM3 <br />�{?' l 3S3 - j000 <br />PROPOSED USE OF BUILDING <br />BnWiding McCha' Cal <br />AdIlbin <br />HEAT SOURCE <br />PERMIT <br />Combination LR.1 PIUmbing <br />p <br />WORK <br />{R( Allera ion <br />Electric <br />c ,!J <br />TYPE <br />I <br />Demolition Sign <br />TYPE <br />I <br />Uq New <br />Gas <br />I <br />I_ '\ <br />Sprinkler <br />u Re air/Main( <br />Other <br />CONTRACT PRICE OF WORK �/ / O/ OHO <br />(D <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />Cw S F-K'.e-T A1'fW S IC I` <br />PLUMBING <br />NO. TYPE OF (TORE OR ITEM <br />MECHANICAL <br />N0. I TYPE OF FIXTURE OR ITEM <br />S <br />WATER CLOSET (TOILET) <br />BATHTUB W/ XJIIII "'Ill <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR MOP/ETC.) <br />OTHER <br />1 <br />I <br />I <br />= <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />I <br />I <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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW Rf GULATING CONS i RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER PF THIS PROPE TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFill LAW 1 BJ27 RCW AND 296.200 WAC. <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />