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SITE ADDRESS <br />L�L LOTNO. <br />DESC. <br />OWNER <br />- `f�--�-'-_ <br />TENANT NF.ME <br />61oolnr�n <br />CONTRACTOR 1.. <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 />PARCEL TAX I.D. # <br />BLOCK I TRACT� <br />� <br />� <br />PHONE /fyr���L��I/+S <br />� (!% �f }y <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORKDESCRIPTION �,_ � <br />8�x y27G <br />CONTACTNAME <br />PERMIT # <br />Bo �9-�3L <br />PHONE <br />'► gZ� 77G-?11a� <br />PHONE <br />�-7�G- Z�ao <br />AODRESS ZIP CONTP..LICENSE# <br />1i,r¢ 5� A� �dhawll� k?} 9�OZ� W!L Ct� �l9�f � fl <br />uilding <br />PERMIT COmbinaliOn <br />TYPE Demo�itio� <br />Sprinkler <br />Mechanical <br />Plumbing <br />Sign <br />Addilian <br />Atleretion <br />New <br />RepalrlMainl. <br />HEATSOURCE <br />Eleclric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />M�p'w�'�- � ah �k+� �'LqS,� S�R�G <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />B�\THTUB <br />LAVATnRY (WASH BASIN) <br />SHOWER <br />KITCHEN SIN4 8 DISPOSAL <br />DISPiWPSN-R <br />LAUND'iY TRAY <br />CLOiNES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAF2/MOP/ETC.) <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC—AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACEISTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GA� RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN UR <br />NOT. THE GRANTING Gr A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AtJY OTHER <br />STATE OR LO REG LATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF T I O ERT TO PERFORt,1 THE WORK FOR WHICH APPLICATION IS MADE AND i COMPLY WITH THE STATE <br />CONTRACT W 82 CW AND 296200 WAG �/��Z <br />�� <br />Signalure ned o acto /Authorized Agent Date �/y <br />