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� <br />S TE ACDHESS <br />02 N .� <br />LEGA L0T N0. <br />DESC. <br />C <br />F�_RMIT APPLICATI�.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />Y �E <br />BLOCK �RACT <br />Qc(l.C�i <br />PARCEL TAX I.D, 7! <br />iSas S� �� <br />TENANT NAME CONTACT Ni1ME PHONE <br />�uc�c�y I <br />CONTRACTOR ADDRESS LP CONTR.LICENSEM <br />W�t.4_1 pr(v+� I��e�{�1ul�L l f�. �03 -5M�'T'�4 ,f�1C� W, u.i,�n � 0'3� f� <br />�� 303 0�� ���-�— cnx� `�8?�1 <br />PROPOSED USE OF BUILDING <br />CONTRACT CRICE OF WORK <br />1YORK �ESCRIpiION <br />Building Mechanical Addition HEAT SOURCE <br />PERMIT R Combination �Plumbing WORK �Aiteration � Electric <br />TYPE D Demolition Sign TYpE New Gas <br />U Sp�inkle� RepaidMeint. Other <br />7� ^� CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />�•: ► �'� • \ � <br />� � � „� � <br />N0. � TYPE OF FIXTURE OA ITEM <br />WATEF CLOSET <br />_ BATHTUB <br />LAVP.TORY (WASH BASiN) <br />_ SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISHWASHER <br />_ L.4UNDRY TRAY <br />_ CLOTHES WASHER <br />__ UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV[NTER <br />_ SINK (SERVICE/BAR/t�10P/ETC.) <br />� 0 HJ ER_� <br />�T � <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/G — NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEfl <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEflEBV CER!TIFV THAT I HAVE READ 4ND EXAMINED THIS APPLICATION AND KNOW i HE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIIJ OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PFESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROV1610N OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONS'RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNE 5 PPOP R7`! TO PERFOR TNE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C ACT Vy1 .27 AND29 OOWAC. ��/Z�O� <br />l <br />