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� <br />SiTf: ' , ��rl�SS <br />, ;=.�/1 �� 1(>� <br />DESC. <br />�RMIT APPLIC.�4Tf�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, FVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-II857 <br />PARCEL TAX I.D. N <br />�%uPle�i' Q'��13-1 Oo I p <br />�� ��������IY�X�� <br />TcNpNTNAMF <br />S�buC� r�-� <br />CONTRACTOR <br />C--rne�ce,l�CU�e I� <br />PHONE <br />��-R�� _Cf,tit <br />PROPOSED USE OF BUIL�ING <br />Co,r�,�wnczf • <br />TRACT <br />PERMIT q <br />Mo3 d 3—��a <br />I���q �3'� A- W ���'J, c-�.�oas� <br />CONTACT NAh7E <br />('�( V <br />PHONE <br />�►9 <br />A�ORES� ZIP CONTR. LICENSE N <br />�v�t3 6�'"G�eS �1�, W�- �U3Z �'/n�-�fl=os� <br />Buildiny �rvx Mechanical <br />PERh71T g Combination I) Plumbing <br />TYPE Demolilion � Sign <br />B Sprinkler <br />CONTRACT PR�CE OF WOflK ��� ,rl�., I�(j <br />�aatU <br />WORK DESCFiIPTION 1 �S�l I„Ui�Q <br />�s � � A�. c� �c�xx k.. <br />�an wl (�-'��rx . c�u.�4�xsk- <br />NO. � TYPE OF FIXTURE Ofl ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />B4CKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Addition <br />WOFK Alteration <br />IYPE New <br />RepaidMainl. <br />tIEAT SOURCE <br />�Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3705 <br />�as� �l?� f�-�c_ u,n �-4- �'ur S'�rb�,cks �o- � eKl�u�1' <br />�' 6�man I r��U 0'�e c-�xSj -h;p �n;�, 1�1c}��� <br />N0. I 1'YPE OF FIXTURE OR ITEM <br />�/ A/C—A/HANDLINGUNITS <br />FORCED AIR SYSTGMS <br />HEATPUMP <br />UNIT HEATERS <br />c° CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />� EXHAUST �AiJ <br />OTHER <br />I HEREBY CERITIFY THi.T I HAVE READ AND EXAMINED THIS AP?LICATICN AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS'YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO �IVE AUTHOR�IY TO VIOLATE OR CANC:EI TF'E PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW FEGULATING CONSTRUC710N OR THE PERFORh1ANCE OF CONSTRUCTION. 7N,\T I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEflFORM THE'NORK FOR WHICH APPLICATION IS MADE AND I GOMPLY WITH THE STATE <br />CONTRACT05$ LAW 18.27 qCW AND �96.200 WAC. <br />3 -a � -�3 � <br />Date � 2 <br />�' � � <br />� <br />