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SITE ADORE/SS� <br />i0 i0 C� U l <br />LEGA LOT NO. <br />� <br />PERMIT APPLICATIO� <br />CITY OF EVERETT PERMIT SERVI�ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� <br />SLOCK <br />TRACT <br />PARCEL TAX I.D. • <br />PERMIT � <br />,L U 'y-6�F-ol� <br />su zo n��. <br />4Jooalbw•� Lao���ti� �s�• �'�ao� yjs -ys s-a�o, <br />TENANT NAME I CONTACT NAME PXONE <br />CONTRACTOR �y ��bic+� Sf°F" ADDRESS 21P CONTR. LICENSE M <br />She�-t Mofa/ /G//6./�n.ii�♦ Q1F•�('l! EUE�P6'SSO��cT <br />PMONE a53-j//y (/iaw 0� <br />PROPOSEG USE OF BUILDINO <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK � 3 y// � <br />WORK DEBCRIPTON ��'�(,Q � <br />NO. <br />TYPE OF FlICTURE OR ITEM <br />WATER CLCdET <br />BATHTUB <br />LAVATCiiY (WASH BASIN) <br />SHON:ER <br />KITCHEN SINK 8 DISPOSAL <br />D!oHWASHER <br />�,4UNDRY TRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAFUMOP/ETC.) <br />OTHER <br />RBuilding echenical Addition MEATSOURCE <br />I..! Combinelion Plumbing WORK RI../ Anerallon Elactric <br />�.J Demolitlon Sign TYPE �._j Nrw �Gas <br />l.� Sprinklar U Repair/Meint. U Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />NwT <br />NO. I 1�'FE OF FlXTURE OR ITEM <br />A/C -AMANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DP,YER <br />FANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />CiAS FIREPLACE <br />�AS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW ThiE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY O7HER <br />STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I NM AUTMORIZED BV THE <br />OWNER OF THIS PPOPERTY TO PERFORM THE WORK FOH WHICH APPLICATION IS MADE AND I COMPIY W�TH THE STATE <br />CONTRACTOAS LAW 18.27 RCW AND 29fi.200 WAC. <br />r x� y-�-� z <br />