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SITcE ADDRESS <br />o`I�Z <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />i',�,«.:,,�n_ V�� <br />� EF�MIT APPLICATiJN <br />CITY OF EVERETT PERMIT SER'VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-P857 <br />�'ao� <br />���r_ a�<� � <br />�v <br />BLOCK <br />�arl� <br />TEN A E <br />� �, �.. Q .� <br />PARCEL TAX I.D. # <br />TRACT <br />A�DRESS <br />g`%;� � ���-��u�, �-t� <br />CONTACTNAME <br />%�i�nr-� S-�rL�..�a� <br />CONTRACTOR k� I ADDRESS <br />���ic�,��, h¢Storc����.� �vC. <br />�VCI'u'f" �.i� <br />PHONE <br />� � <br />���-���� <br />w'-� <br />��'zS) �6�-5;255 <br />ZIP CONTR. LICENSE N <br />PHONE �f�'S $S�L-�`)"3b �S�i � I�`I���,����lh ��'i..o-.d l--A <br />PROPOSED USE OF BUILDING <br />8uilding Mechanical <br />PERM�T R Combination R Plumbing <br />TYPE Demolition � Sign <br />B Sprinkler (t+of heads) <br />CONTRACTPRICEOFWORK�'�wY� �,`��,�-�. <br />WORK DESCRIPTION � �J . <br />rl(`-�... r^.'�q� l�^(�xY,(' <br />I <br />!O'°' <br />� �; C�M-IS <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LF,VATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 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 />n Additlon I HEAT 50URCE <br />�—� Alteration Eleciric <br />� ,� New Ges <br />L'Y RepaidMaint. Other <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br />� <br />NO. I TYPE OF FIKfURE OR REM <br />A!C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <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 />EXHAUSTFAN <br />OTHER _ <br />I HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH 6YHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh11T �OES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR L�AL LAW HEGULATING CONSTqUCTION OR THE PERFORMANCE OF CONSTRUCTION. THA i� AM AUTHOr�.IZED BY THE <br />OWNEFj-6F I PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION iS MADE AND I COh7PLY WITH THE STATE <br />CONT,FiAC R LA�V 18.27 RCW AND 296200 WAC. <br />l 2�Z��� <br />