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SITE ADORESS <br />LOT NO. <br />�-,A-� � in� <br />TENANT NAME � <br />���r- 1 Y /�-Ll � <br />CO TRACTOR <br />�h���=� r=���= <br />�� <br />PHONE <br />PEF�JIIT APPLICATIOn� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PROPOSE� USE OF BUILDING <br />F- c-17`"I L_ I <br />-(�r--rv ���/�t�Ell-�-t-� <br />CONTflACT PRICE OF WOFiK �j L <br />TRACT <br />PARCEL TAX I.D. q <br />'1�2+"Vt. lJ�(-fNfEPCc=�C�c- `�CG�'(o <br />NAtdE � PHONE <br />� � � C/ %a.7/�'T' `IZSzIF`'�,z _ —�G�S� <br />�DFE5S <br />i�17<�f_� 1�14 � �,.�c iUL <br />l,L��.�fN����.L <br />8uilding Mechanical <br />PERh71T Combination Plumhing <br />TYPE ��Demolition Sign <br />Sprinkler <br />ZIP <br />���o(Z <br />CONTR.UCENSEM <br />�i�/i�FF�I`�1t�> <br />Addilion <br />K Alleralicn <br />New <br />Repair/Pdaint. <br />HEATSOURCE <br />Electric <br />Gas <br />O�her <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK qESCRIPTION <br />/1� Z I�,- b�7�Ji� �'� �i?Y I���;Dr�ti.�is � l-�r-rv I a f'��-�Dr�.i�s <br />�tZc,c,�-t� i " L��(ar.� LL�--� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTU� <br />LAVATORY (WASFi BASIN) <br />SHOWER <br />4(ITCHEN SINI( 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVGNTER <br />SINK (SERVICE/9AR/MOP/ETC.) <br />OTHEF <br />N0. I TYPE OF FIXTURE OR ITEh1 <br />/VC — A/HANDLING UNITS <br />FORCED AIR SYSTE�15 <br />HEAT PUMF <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACF/STOVE <br />FIREPUICE INSERT <br />GAS FIREPLAC� <br />GAS RANGE <br />GAS PIPING <br />rXHAUST FAN <br />OTHER_/'tPC �f�-lul�(�—k'S <br />I HERE6Y CERITIFY THAT I HAVE READ AND EXA�.IINED THIS APPLICATIGN AND KNOW THE SA�dE TO 8E TFUE AND CORFI�CT. ALL <br />PROVISIONS OF LA�VS HND ORIDINACES GOVERNING THIS TO'PE OF NJORK WILL BE COP,IPLIED'NI7'H Y�JHE7HER SPECIFIF�D HEREIN OR <br />NOi. THE GRAi JTIPJG OF i1 PERPdIT OOCS NOT PRESUAIE TO GIV[ AUTHORITY TO VIOLITE Oi'i CANCEL THE PRO� ISION OF ANY OTH'tn <br />STATE OR LOCAL LA�N flEGUL1TING CONSTRUCTION OR THE PERFOR�.fANCE OP CONST�9UCT10�. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORP+1 THE `NORK FOR WHICH APFLICATION IS h1ADE ANO I CUGIPLY `+:9TH THE STATE <br />CONTRAC S LAW 16.27 RCW AND 2a6.200 WAC. <br />�%-��cti I � �f `�-�_��.� <br />