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SITE ADDRE33 <br />�015 i�Uc <br />LEGA LOT N0. <br />�rRMIT APPLICAT�UN <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. N <br />S�h� -1 � �M���. Po 8ox � v� � <br />TENANT NAME CONTACT FOR PERMIT <br />IJ��� ��� <br />CONTRACTOR <br />Ow�ne r <br />PHONE <br />PROPOSrED USE OF BUILDING <br />(�eS �d e.n� �a ( <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION � <br />C'�w9�1� <br />NO. I 1'YFE OF FIXTURE OR 17EM <br />WATER CL�SET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRE�ENTER <br />SINK (SERVI�E/BAR/MOPIETC.) <br />OTHER <br />P RMIT # <br />�OS �� -O�19 <br />ADORESS <br />[� Bulldln� Mechanical <br />PERMIT I7 Comb�natlon � Piumbinp WORI <br />TYPE � Dem.oliflon U Slgn TNPE <br />Sp! inkler <br />ZIP COHTR. LICENSE N <br />naamon <br />acer�uor� <br />New <br />RepalrlMalnl. <br />HEATSOURGh <br />�Eledric <br />Gaa <br />Other <br />C�TY OF EVERETT LOG/LL s�u.eo I M V V VL �J +��• <br />I C'Ar c�ac��e �v c <br />N0. I <br />Z C�ar (Sa�aqe_ <br />TYPE OF FIXTURE OR ITEM <br />AIC — AIHANOLING 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 />EXHAUST FAN <br />OTHER <br />I HtREBY CERITIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRO'JISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPI.IED WITH WMETHER SPECIF�ED HEREIN OR <br />NOT. T�yE GRANTING JF A PERMIT DOES NOT PRESUtAE TO GIVE AUTHORITV TO VIOV+TE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGUV+TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEI. OF TMIS PROPERTY TO PERfORM THE WORK FOR WHICH APFLICATION IS MADE AND I COMPLY WITH TNE STATE <br />DEBIT 8 CREDIT CAROS ARE NOT ACCEPTED <br />� <br />