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PERMIT APPL.ICRTION <br />CITY OF EVERETT PERMIT SERVICFS <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS I/ <br />/ v , / �� 1 <br />� � � r �� <br />LEGA LOT NO, I <br />TENANTNAME <br />PARCEL TAX I.D. A <br />TRACT <br />CONTACT <br />CON�R[�CTOR � ADDRESS <br />�J � / //� � .-% <br />PHONE2%C `� ��ttl��$��ct�Sikl�'.• •S.�S^�Jc�.`i4, <br />��,G �23-1� � Z_- - <br />PROPOSED USE OF BUILDING � Buildiflg r Mechanical <br />I PERMIT Combination r' Plumbing <br />TYPE Demolition �� Sign <br />— Sprinklor �a ol ioads) <br />CONTRACT PRICE OF WORK <br />WORK �ESCFlIPTIUN <br />�' '� <br />` '� Y" � � t �i� <br />w <br />✓E�� � L G�S <br />N0. I TYPE OF FIXTURE OR ITEM <br />W.4TER CLOSET (TOILET) <br />BATHTU� <br />. LAVA-iORY (WASH BASIM) <br />SHOWER <br />KITCHEh SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAI' <br />CLOTHES WASHEN <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PR[VENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PEar,�ir a <br />G 7 g o30 � -0_�_ <br />ZIP PHONE <br />�rG GZ3-(2Z Z <br />PHONE ! <br />ZIP CONTR. LICENSE k <br />s�� vt N' 9�"/o S <br />r'A �f �'�i' z -,� � � �G, <br />Addilion I HEATSOURCE I <br />Alle tion n Eluctric <br />New � Gas <br />RepaidMaint. Other � <br />CITV OF EVEFEiT LOCAL SALES TAX CODE IS 3105 <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C – NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER iiEATER <br />METAL FIRE?LACE/STOVF. <br />_ FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBV CERITIFV THAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAh1E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNWG THIS TYPE OF WORK WILL BE COMPLIED WIiH WHE:�H[R SPECIFIED HEREIN OR <br />NOT. Tfi[ GRANTING OF A PERh11T DOES NOT PRESUI�IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE QR-6pCAL LAW R GULATING CONSTRUCTION OR THE PERFOFt.1ANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWN /i OF HIS PR� ER TO EFFOFM THE WORK FOR WHICH APPLICATION IS M/�DE AND I COMPLY WITH THE STATE <br />COI�RQCT�RS, � O �1�✓AND 296.200 WAC. / / <br />. <br />� <br />��23 <br />