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SITE ADDRESS <br />�; � ���� <br />LEGA LOT NO. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />�f�/c'A- C Lj�tCYJ� �� <br />TENANTNAME <br />CON7RACTOR O�C/,� <br />PHONE <br />PROPOSED USE OF BUIL�ING <br />!��%fC <br />CONTRACT PRICE OF WORh <br />WORK DESCRIPTION <br />PARCEL TAX t.D. N <br />� 3G / <br />TRACT <br />CONTACTNAME <br />-�� c�(G,�<-�6� <br />ADDRESS <br />Building DMechanical <br />PERMI7 R Combinetion U Plumbing <br />TYPE Demolition U Sign <br />Sprinkler (u of heads� <br />% r `.. ; <br />PERMIT k <br />Bo3o i <br />PHONE <br />9z� z.SZ-, <br />� <br />LP COtdTR. LICENSE N' <br />A ition HEAT SOURCE <br />WORK Al�erution R Electric <br />TYPE New �.j Gas <br />qepairlMaint. L� Othor <br />CITY OF EVERETT L�CAL SALES TAX CODE IS 3105 <br />�'�l�!�riL �--vr•>>r.v�7 �•9r �cq=- ,��Jr�a ,t/6� �///� nao% p�ri <br />�i�`�7/�fj G�'CC/L� _ �IS� S�F.� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LA'✓ATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINA� <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/f_TC J <br />OTHER_ _ <br />N0. I TYPE OF FI%TURE OR ITEM <br />PJC — A/HANDLING UNITS <br />FORCED A�R SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATEii <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I fiEREBY CERITIFY THAT � HAVE REA� ANO C-XAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AIJD ORIDINACES GOVERIJING THIS Tl'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />IJOT. THE GRANTING OF A PEFMIT DOES NOT PRESUIdE TO GNE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STAT[ OR LOCAL LAW REGULATWG CONSTRUGTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFiIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COIdPLY WITH THE STAT-. <br />CONTRACTOFS LHW�7 RCW AND 296.?0B'�/AC. <br />�_ 1�/(��� � <br />�d Agenl Da�e �/ai <br />