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, <br />SITE ADDRESS <br />�/03 '' E <br />LEGA LOi � . <br />DESC. L <br />� G �MIT A,PPLICAT(_:��_J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA d8201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK i TRACT <br />PARCEL TAX I.D. M <br />2� <br />C��a -��� <br />M/c.�/i�-f�4-/�k-A�nO `���'OcsY 30� IiuvA�� G-JN�b''�/� (��F�Ff/�-�`%3 <br />TENANTNAME I CONTACTNAME PHONE <br />CONTR4CTOR /' AODRESS ^ZIP CONTR. LICENSE N <br />�[ C.�/� ��ahEC,of/Si7�[.�t�J�G �3�*K 30% �u✓.acc�I�JTI 7��0/� <br />PHONE <br />��6F,i �/7- ��//3 <br />PROPOSED USE OF BUILOING <br />S/i./E.L4' r'HM���� <br />Bullding Mechanical <br />PEHMIT Combinelion Piumbing <br />TYPE � Demalition Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK �,$ � f� ���b <br />WORK OESCRIPTION <br />�t�c� <br />'�uc2Cc jfr6T T <br />Addition <br />Allemlion <br />New <br />Repair/Maint. <br />HEATSOURCE <br />Elnctric <br />u05 <br />Olher <br />CITY OF EVERE7T LOCAL SALES TAX COUE IS 3705 <br />W6bai /'ti'.ff-l� �NS[E' /`�/jn7i�y ��i �EiK'E � � �/ /' O: <br />� <br />�e��- �2 S � �ra'�-r� � �r n-rr= <br />NO. I TYPE OF FI7CTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEfJ SINK 8 DISPOSAL <br />/ DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOH DRAIN <br />BAC�<FLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHtR <br />NO. I Tl'PE OF FI%TURE OR ITEM <br />A/C - A/HAN^LING UNITS <br />FORCED AIR S'� STEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSE•RT <br />GAS FIREPLACE <br />GAS FANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERRIFY'HAT I HAVE READ AND EXA�dINEU THIS APPUCATION AND KNOW THE SA�dE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF 1�1WS AND CRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPI.IED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PE.RMIT OOES NOT PRESUME TO GIVE AUTHOFiITY TO VIOLATE OR CANCEL 7HE PROVISION OF ANY OTHEP <br />STATE OR LOCAL,kAW REGULATING GONSTRUCTIGN OF THE PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS hfiOPERIY TO PERFQRM THE W�RK FOR'NHICH APPLICATION IS MAOE AND I CUMPLY WITH THE STATE <br />CONTfiACTOFS LA,N% 18.27 FCW AND 296.2yff WAC. <br />