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PE��MIT APPLICATI4�� <br />CITY OF EVERETT PERMIT SERVICES <br />' 3200 CEDAR STREET, EVERETT,INA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE A�GRE55 <br />�I6v ( ����- ���^ <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER <br />TENANTNAME n � _ <br />o�L,�4� (=�vzc= <br />PHf7NE,Z� 6 �7.Z 3 C <br />/ <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />TRACT <br />PERMIT N <br />k�aa9-ool <br />yz S' y.3c9 oz�l <br />ICONTACT ME � PHONE <br />�c�t l�v [_2 Q/L %�G.l `� �% Z 3 �%3 f z <br />A�DRESS <br />�✓lfll L �-T(d� � ( (,CS'/�'vL <br />.3 -�/Z �?ud ZYo�I�%Z <br />ZIP CONTH. i-i�tnse n <br />S[3�( S.C�ci(� S�r- �//$ <br />Building Q Mechanical <br />PERMIT � Combinalion U Plumbing <br />TYPE Demolitian �� Sign <br />Sprinkler <br />c c p(.v (3 a O�LTt_Zi F/' �i�7 �� <br />TYPE <br />n Additian <br />�� Alteretion <br />pr New <br />L) FepaidMaim. <br />HEATSOURCE <br />Eleclric <br />Gas <br />Othe• <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3�us <br />WORK DESCRIPTION `— <br />i=��2� s��P�c--�s�b�- sy.s-�e.t,. /�—S7��L��-?'Id� <br />1.0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRaY <br />CLOTHES WASHEF <br />UNINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />�r r�---'Y1i. <br />� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A1C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIFEPLACE/STOVE <br />FIREPLACEINSFRT <br />GAS FIREPLACE <br />GAS RA��GE <br />GAS PIPING <br />EXHAUSTFAN <br />O�HEti <br />�'Yc S�p SS u <br />S-�,$ �%�ti� <br />I HEREBY CERITIFV'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOIN THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LA'P1S AND ORIDINAC[S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OF <br />NOT. THE GRANTING OF A PERMIT OQES NOT PRESUME TO GIVE AUThIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8� THE <br />OWNER OF THIS PROPERIY TO PEFFORM THE WORK FOR WHICH APPLICATIOtJ IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCN� AND 296200 WAC. � <br />Nf /Gut2 n %1 %C--�'� d % D .� <br />