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� _RNi�� APRLiCA�'�JN <br />CITY OF EVERETT PERII�IT S�RVIC�S <br />3200 CEDAFi STREET, EVERETT, V�'A 98201 <br />425-257•8810 — FAX 425-257-8857 <br />SITE ADDRESS �� PyA�RC�EL TAX I.D. b <br />�i � ' �` ��' � (':A : ��� �U � —aS""IT�..s�"�4 <br />LEGA I.OT N0. BLOCK � TRACT <br />DESC. <br />OWNEH ��� � �/ . ^ ^ .:/ �..-. �a ADDRE53 G��D L <br />� o na.wr,v�Cri��s' - �D.C� . <br />TENA � ME r— CONTACTNAME <br />I( ��}`,�, (.�:�'r��� ��r.v�,�Q�l,l�a1.� <br />PHONE <br />PROPOSE� USE OF BUILDING <br />U"i v� `�hru.� <br />CONTRACT PRICE OF <br />� <br />� 7�/I <br />PERMIT <br />TVPE <br />� ,__ <br />�� ���v,., _�„ c .-, , <br />Gv D ? o ; - o.a <br />PERMIT M <br />R�� 3 03 -03� <br />% <br />PMONE <br />LP CONTR. 110ENSE N <br />A�11FR.1 FG Gb 1 � <br />Building Mechanical Addition HEATSOURCE <br />Combinelion R Plumbina WORK � A��eratlon � E�ectric <br />Demolilion ❑ S(gn TYPE New Ges <br />Sprinkler Repair/Maint. Other <br />%�/rJ�J M CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION � <br />CI:CtSi17,(.�.f" r�.�j2l.11�1-/�'l�il�l I�1�rDV1P.n��S, ��cLe.e.� -fr�m f�'� <br />( �JI� a.� d,Y��V� -f'h ru F�,p►z�S a�S�-a,n�- .�l c� l U'x 1�" _ l� <br />N0. I TYPE OF FlXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FIXTURE OR ITEM <br />� <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRYER <br />RANGE HOOD <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 HEREBY CERITIFY THAT I HAVE READ AND EXAM�NED THIS APPLICATION ANO KNOW THE SAME TO BE TPllE AND CORFECT. AlL <br />PROVISIOVS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOP.ITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF <br />STATE OR LOCAI L4W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TME STATE <br />�. \ R \ �FS LAW �.2� R� � A � 29�.200 WAC. I .�/ , / .. � _ <br />�� <br />'(a <br />