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� <br />� <br />SIT ADORESS <br />�3-0 �c -� <br />LEGA LOT NO. <br />DESC. <br />PE�MIT APPLICATIO� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK � TRACT <br />PARCEL TAX I.D. M <br />l --J�i.-o 9 <br />-O/, <br />l;ai°J�st �'.h�i5�-iau Ce,rfe�- 830 $E �,rtif�►�,i I( G/k�! �iYz03 <br />TENANT NAME I CONTAC:T NAME PHONE <br />CONTRACTOR r1 F�S ��, L ADORESS . �. OX � j I O ZIP CONTR. LICENSE M <br />u��� %�77-��8�-J12�/ /� �FP��.�.�tR��tm� <br />PHONE 1�1�Ylhl�t F��SiWH �SZ6Z <br />\ - <br />PROPOSED 11SE OF BUIL�ING <br />CONTRACT PRICE OF WOflK <br />WORK DESCRIPTION ��ni( <br />NO. � TYPE OF FIXTURE OR ITEM <br />Building Mechanical <br />PERMIT Comhination R Plum6ing <br />TYPE Demalition ❑ Sign <br />Sprinkler <br />�_ <br />eY�at�� <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOFi �RAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Addition HFAT SOURCE <br />WORK Alteralion Electric <br />TYPE New � Gas <br />Repair/MainL U Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />$ yl'ILr+ 'Fd LO%� '? k- ��/ <br />y,/14t�- <br />NO. I T'!PE OF Fp(TURE OR ITEM <br />A/C — A/HANDLING UNITS <br />� FOHCED AIR SYSTEhiS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <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 />I HEFEBY CEi71TIFY THAT I HAVE READ AND EXAPdINED THIS APPLICATION AND KNOW THE SAME TO BE TFUE AND CORFECT. ALL <br />PROVISIONS OF L1WS AND OFIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHE(; <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofi THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEf;1Y TO PERFORM THE'NORK FOR WHICH APPLICATION IS PdADE AND I COMPLY WITH THE STATE <br />Ce �NTRACTORS lAW 1827 RCW AfJD 296.200 WAC. !� <br />. )�,im �,...� 12� �D�nb <br />�' <br />