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• <br /> PERMIT APPLICATION <br /> 4177. CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS "tt- PARCEL TAX I.D.# PERMIT# <br /> x-32 C S_ y /4+.,c p o 5 col-1 o .)-7 0 2-/oo f o 3- S� <br /> LEGAL LOT NO. ZJ • <br /> • ZZ BLOCK TRACT <br /> DESC. - ('b 7 I i. A <br /> OWNER ADDRESS ZIP PHONE <br /> CV4 'Sols y32S S- AA' t..,r c17- 53203 yzr 277 cp7o <br /> TENANT NAME CONTACT NAME PHONE <br /> E o 0 L.5o n, 2-s Sb 8 £l 7 S2 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> ?.4c1c e AreAc s /1/4.1 2,2,2-G ,e%) 'ctx A-44e- ,E.vemf+l'967c,, <br /> PHONE1/ C') -) O SI�SN <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> GAG/ PERMIT Combination Plumbing WORK Alteration ectric <br /> TYPE Demolition Sign TYPE New Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK 3 ( 00 6.O 0 Li( f 0 I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION e' /U57Y1,uG-r SeN6Lg. s.Tvozy (o 52•S G�QP'4- J <br /> 2_4?-5-0, f4-&-.4-6 O EA.) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET NC-A/HANDLING UNITS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER i UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY I WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) ( EXHAUST FAN <br /> OTHER OTHER <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 REGULATING CONSTRUCTION OR 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 /> CONTRACTOR AW 18.27 RCW AND 296.200 WAC. <br /> Signat re of Owner/Contractor/Authorized Agent Date <br /> lZ <br />