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SITE ADDRESS <br />05 CA6o <br />LEGA LOT N0. <br />DESC. Q Q <br />OWNER <br />f� � «� N <br />P�.�MIT APPLICATId'. J <br />CITY OF EVERETT PERMIT SENVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425•257-8810 - FAX 425-257-8857 <br />FARCEI TAX I.D. +1 PERMi7 M <br />� ��D ��o3q aodo�l�ou rnuyo - <br />BLOCK TRACT <br />ooCO-oo BEu �'l �cS �v 5- g�K- �oo i�-oo -l�T4o <br />ADORESS LP PMONE y2r� 353 <br />o Pi<<� s �o s CA6or ,Qo� .�� /,c� �bZo3 .�'+s� <br />TENANTNAME I CONTACTNAME PHONE <br />Sffim � S �vt � Si9ri'� � <br />CONTRAC'OR //�, / ENE/wi 7 SE` V��ADDRESS LP CONTR. LICENSE N <br />i�� I"v AR�iaa�a�1 l.�4- - 9b 't3 - G3'/G <br />PHONE �y2� 5•�y_ a��� <br />PROPOSED USE OF BUILOIN6 <br />5 �F�% PERMIT <br />/� TYPE <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />< <br />l40�0 (/s�l�. aE �3 NWEN�.st 949N1� <br />Building 1�(Mechenical Addlllon HEAT SOURCE <br />Combination H Plumbing WORK Allerailon 1p�� Ele�,�ric <br />Demolition U Sign TYPE New �J Qes <br />Sprinkler Repair/Maini. U O�her <br />�.Q � —C � �., <br />/� �'�tr p t�v�n P� r� �c c r�� R�c <br />� NO. <br />I _ <br />TVPE OF Fl7CTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWEFi <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />� DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEFVICEiOAR/MOP/ETC.) <br />OTHER <br />CITY Jf EVERETT IOCAL SALES TA7C CODE IS 7105 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />fORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATER5 <br />CIOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPIN� <br />EJ(HAUST FAN <br />OTHER_ <br />i HEREBV CERITIFY'HAT I HAVE REAO AND ERAMINED 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 COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE AUTHORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STA7E OF LOCAL LAW REGVLATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWPIER OF iHISPPOPERN TO PERFUpM THE WORK FOR WHICH APPLICA110N IS MADE AND I COMPLY WITH THE STATE <br />�3 oy <br />