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P�RMIT APPLICATILN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />�So � c <br />LEGA LOT NO. <br />TENANTNAME <br />CONTRACTOR <br />SM rril �oN �S'�ucJ7p,,/ <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTON <br />2�i'<.��E <br />PARCEL T!U( I.D.11 <br />l'��f57w1 <br />BLOCK TRACT <br />ADDRE55 <br />03 2�Ay'AvF Fvr-aei-7, wr1. 9k2o� <br />—T I CONTACTNAME <br />ACDRESS <br />/o�j27'a� rr0/� I.E. gj>2p$ <br />Bui�ding Mechanical <br />PEHMIT R Combination � Plumbing <br />TYPE D Demolitian Sign <br />U Sprinkler <br />rtor u,s?�'Efl T�n�h� <br />NO. I TYPE OF FI%TURE 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 />DRIWKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOW PREVENTEA <br />SINK (SERVICElBAR/MOP/ETC.J <br />OTHER <br />� <br />PERMIT M <br />o, ra- o <br />ZIP PHON[ <br />'�- 3SSG-s"2s� <br />PHONE <br />ZIP CONTR. LICENSE M <br />c - i�S n, / <br />Adtlitlon HEAT SOURCE <br />WORK R�.j Alleration R Etectric <br />TYPE Q..][ New L% Gas <br />LJ RepaidMaint. L� O�her <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />TYPE OF FIXTURE OR ITEM <br />A/C—A/HANOLING U'JITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATEF; <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HE(iEBY CERITIFY?HAT I HNVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN� COFRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PEt;MiT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE Oii LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFOFMANCE 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 THE STATE <br />CONTRACTQRS LAW 18.27 fiCV�(/AND29fi200 WAC. <br />DEc O l <br />