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� <br />�. <br />SITE ADDRESS <br />%� LEGA LOT NO. <br />TENANTNAME <br />PERMIT APPLICATIO <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EWERETT, WA 98201 <br />425-257-88i 0 - FAX 425-257-8857 <br />/ktL <br />SfEG <br />BLOCK I TflACT <br />PARCEL TAX I.D. # <br />CJNTACTNAME <br />O//d-O!q <br />. <br />PERMIT M <br />PHONE <br />S'Tf} r� FA-�l r1 � <br />CONTRACTOfl ADORESS � � ���OWS R� ZIP CONTR. LICENSE X <br />UNl U��S•9L /hFC�'�u�CAL SFa✓ic� gi <br />PHONE 9B v sz <br />�%ZS-�S-9��a .�nJi�i�n.s�.�.�, <br />PROPOSED USE OF BUILDING <br />12.�7A-/L�D iF-/�',E <br />Buildfng ���jjj Mechanical <br />PERMIT B Combination" � Plumbing <br />TYPE D Demolil,�n � Sign <br />U Sprinkler <br />Addition HEAT SOURCE <br />WORK R Alteration � Electric <br />TYPE D New Gas <br />D Repair/MainL Other <br />CONTRACT PRICE OF WOflK �I�.V �` CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />7 <br />WORK DESCRIPTION <br />/Nstg��.� cEic.,Nc �i+.�cas� ,Ex,u.ausr f.e�aJ ,.rJ �t.%c�od^+,2��oc.�-T.� <br />77f E Lo ✓n� <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FlXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT fiEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />CF./r.iNc ctic�s.Aweµwo� <br />I HERE2Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AN� KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AN� ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERM�T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION C' qNY OTHER <br />STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AIJD 296.200 WAC. <br />� L ��L�'"�i <br />