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- - I 4A.L 4 u l%A— X.)d <br />PERMIT APPLICATION 6106CL DNP"y <br />CITY OF EVERETT PERMIT SERVICES gas )c`# zzL(Z <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />d 25-2c 7-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX LD. N PERMIT n <br />IsL7 93 Rb PL acE S LA) - 1--- — -� C ON(rs off _ <br />DESC, J 3 LEGA T NO 3, / BLOCK r TRACT <br />OWNER 7 ADDRESS ZIP PHONE <br />cr"-T 90( 4"`&ZeA-1 i.Je , Pold.5X/S79'9afz91 142 r) 3� 3- fodv <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE 0 <br />cm-T- XA4 c As Add ar �rviSSAI *�LogsM3 <br />P NE <br />ZJ j 3S3-�j000 _ <br />PROPOSED USE OF BUILDING [i Building li Mechanical Addition HEAT SOURCE <br />PERMIT I)� Combination FFL--J{( Plumbing IWOR✓. P Alleration li Eleclnc <br />(� TYPE B Demolition Sign TYPE New Ifl`�J�', Gas <br />„ Sprinkler Repjn/Malnt. Cu-.er <br />CONTRACT PRICE OF WORK/ / O/ BOO x Z _/�O CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION CO D `t% J7-t - Ai , <br />cWSr, "x Mrrw stic oe_ — J guIL4)Tn1G -- Z IA Ira WrY9i <br />PLUMBING CA -Ca f1PCII MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM THC r CL a „0 r A 7 NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BAI I - WI J 1 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />A/C — A/HANDLING UNITS <br />1 <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ <br />UNIT HEATERS <br />CLOTHES DRYER <br />I_ <br />RANGE HOOD <br />I <br />WATER HEATER <br />_ <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />= <br />GAS FIREPLACE <br />GAS RANGE <br />_ <br />GAS PIPING <br />CT <br />EYHAUSTFAN <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 R GULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER THIS PROPE Ty <br />TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT FORS LAW 107 RCW AND 296.200 WAC. <br />Signature of O ner/Contractor/Authonzr�tl 79e111 Date L <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED `/ <br />