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PL .EMIT APPLICATIC A <br />CITY OF EVERETT PERMIT SERVICES <br />01/ 7r 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITI'. ADDRESSI� PARCEL TAX I.D. # PERMIT s <br />all ttnCd� �. E L �4L G�- rx03-033-G6(o'OD <br />LEG A LOT NO. BLOCK TRACT <br />DESC. 33 ��h Q� towel( <br />Mtrlvael ��m�-5�'L2 1407''St. Sul Ldm"s,WA- ligmo <br />y3S-9W,- 44,63 <br />TENANT NAME <br />la£,V-+A[ef <br />l�bitlzr1 oaI <br />CONTACT NAME <br />fern s�� <br />„�.to-} 3:5v6 )r PHUNL <br />eu2#etN1s i <br />T Atobiie� l(Sf� <br />I,-�,� <br />-+" <br />CONTRACTOR <br />.Sl 0F'1AD <br />ADDRESS <br />ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING <br />6PERMIT <br />♦v� <br />gBuildingD Mechanical <br />Cornbination I) Plumbing <br />TYPE Demolition D Sign <br />Sprinkler <br />(WORK <br />TYPE <br />Addition <br />R Alteration <br />B New <br />Repair/Maint. <br />HEAT SOUROE <br />Qn�-( Electric <br />v Gas <br />b Other <br />� <br />CONTRACT PRICE OF WORK coo <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />sNO pu � r�e�e- �' �d u�tlt% pq, �( !0� vj&o, Pate. t�aCk 3 pa n <br />TAT <br />PLUMBING I <br />NO. I TYPE OF FIXTURE OR ITEM <br />__....._._.._ <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />NC - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />1 <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />__ <br />HEAT PUMP <br />SHOWER <br />._ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 3 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />._ <br />RANGE HOOD <br />_ <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />CLOTHES WASHER <br />FIREPLACE INSERT <br />URINAL <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE,BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />__ <br />OTHER <br />I HER 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 />CON7;TORS LAW 18 7 RC AND 296.200 WAC. <br />Date <br />Si atu a of Owner C a or/Authorized Agent F t <br />