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� <br />� <br />SITE ADDRESS <br />�2�� <br />LEGA LOT NO. <br />DESC. <br />��cRMIT APPLICAT:'')N <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�a�`� �%il <br />BLOCK I TRACT <br />PARCEL TAX t.D. H <br />2%/ GYJ� <br />PERMIT k <br />v�rvnen quUMt55 ZIP PHONE <br />�4'2$'83U-SZZ <br />3i�l.��e-sea.lD,�Z� 1•z?�5� �V�eb2Tl-IJS� w19i� I�� BE�ZIb`VVg W/� C18C� <br />TENANTNAME � CONTACTNAME PHONE <br />C- <br />� <br />CONTRACTOR <br />tN1ELCo �n1TE�}�2:�"�,ES'ZNL <br />�-q,o�714 <br />PROPOSED USE OF BUILDING <br />c�v���rc.� <br />CONTRACT PpICE OF WOflK <br />WORK DESCRIPTION ,A4 D �' � <br />R�wo2k <br />NO. � TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDAY TRAY <br />_ CLOTHES WASHER <br />URINAL <br />DRINK�NG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/MOP/ETC.) <br />_ OTHER <br />ril-1 N�^�sT��r 2o�-93a--i ► 4� <br />A�DRESS <br />�s3 I � 4s��` w►� � <br />ZIP <br />��q uA I 1 <br />WhtOI$OZq <br />❑ Building [[[��� Mechanical <br />PERMIT L) Combinalion � Plumbing WORK � <br />TYPE D Demolilion Sign 7YPE <br />U Sprinkler <br />CONTR. LICENSE N <br />WI�LC6BL0a8 iV <br />Addition I HEAT SOURCE <br />Alleration � Electric <br />New Gas <br />Fepair/Idaint. Olher <br />CITY OF EVERETT LOCAL SALES TA% CO�E IS 3105 <br />�1Ar+9 5�.11G, <br />D U GT WCYL IC TD hi b�� �tOC.W2- J� �-/�rP <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C -AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES GRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FA ��,Z � <br />L OTHER J� J>t/� f}�OeK <br />� HERE�3Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 6E TRUE AN� COFRECT. ALL <br />PROVISIONS OF LAWS AND �JRIDINACES GOVERNINi3 THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERPdIT DOES NOT F�-ESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LCCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH APPLICATION IS M11ADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 1827 RCW AND 296.200 WAC. <br />�� � � ��� ����Z <br />