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� <br />`� <br />SITE ADDRESS <br />LOT NO. <br />DESC. <br />� ERMIT APPLICAT'�7N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-2F'-881 D - FAX 425-257-8857 <br />I �U j`F V <br />BLOCK TRACT <br />PARCEL TAX I.D. � <br />.Xa a i/-oa9 <br />i��1�. pU �'S� 13 t�2� <br />TENANT NAM11E ' I CONTACT NAME PHONE <br />p� ����,- K�� H-6w1S�2.�T 2�6-n3o-�1�10 <br />CONTRACTOR AODRESS ZIP CONTR. LICENSE A <br />H�-1.[ � E�rs� P2.�5��5 3�L. "u1531 5� 45Tu �,UH � <br />PHONE <br />zCl�-�i3� -�)y0 <br />PROPOSED USE OF BUILOING <br />�E� S1aRL�� <br />LSS�vFlN WF� <br />Building Mechanical <br />PERMIT B Combinalion �lumbing <br />TYPE D Demolition Sign <br />U Sprinkler <br />CONTRACT PRICE OF WORK /�.z� O(j <br />.T <br />WORK DESCRIPTION � <br />T�r-�T1-12ao�S �r <br />� P�unneir <br />NO. � TYPE O" FIXTURE OR ITE1d <br />� �Z� rl �=LCoELU8��11 <br />Addition HEAT SOURCE <br />K Alteralian Electric <br />. New � Gas <br />RepairRdainL Uher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />p��v-tr3.17��j I�-O4L P�'T �Toet3'• <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (1VASH BASIN) <br />SHOVJER <br />KITCHEN S'NK 3 DISPOSAL <br />DISHWASHcR <br />LAUNDnYTRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />-1-WT-�rt't�2-,7k�.1�G— <br />NO. � TYPE OF FIXTURE OR REM <br />� <br />A/G -A/HANDLING UNITS <br />FOP�;ED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DNYER <br />F:4NGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHEFi <br />I HEREBY CERITIFY'HAT I F'.1VE F7EAD AND EXAMINED THIS .4PPLICATION ANC KNOW THE SAME TO BF TRUE AND CORRECT. PLL <br />PROVISIONS OF W WS AN�I ORIDINACES GOVERNING THIS TYPE OF WORK WILL BF COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRA�JTING OF � PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTkiER <br />S� ATE OR LOCAL LAW �iEGULATING CONSTRUCTION OR THE PERFORMANCE OF CO�STRUCTION. THAT � AId AUTHORIZED BY THE <br />ON.'NER OF THIS PROPcRTY TO PERFORM THE WORK FOR WHICH APPLICATION �5 ivtnDE AND I COMPLY WITH THE STATE <br />CONTRACTO W 78.2) �:W AND 296.200 WAC. <br />� v �(-2�-02 <br />Signature of Owner/Contra or/Authorized Agent Date � <br />�� <br />� <br />