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� <br />� <br />SITE ADDRESS <br />LOT N0. <br />PCr�MIT APPLICATIG��J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — F AX 425-257-8857 <br />q� c�����n <br />TENANT NAME <br />J <br />BLOCK � TRACT <br />CONTRACTOR <br />c'r� �� STvv� <br />PHONE <br />PROPOSED U£E OF BUILDING <br />CONTRAC7 PRICE OF \ <br />PARCEL TAX I.D. M <br />,5''s'/ �- Fi9i%t' <br />CONTACTNAME <br />ADDRESS <br />Building Mechanical <br />PERMIT Combination R Plumbing WORI <br />7YPE Demolition � Sign TYPE <br />Sprinkler <br />l' <br />ZIP <br />PERMIT N <br />m o�fc-c�� l <br />PHONE <br />CONTR. LICENSE M <br />BAddition HEAT SOURCE <br />Alteratlon D Eiectric <br />BNew I g Gas <br />Repair/MninL � Other <br />CITY OF EVERETT LOCAL SA�E;�.'i AX CODE IS 3105 <br />WORK DESCRIPTION <br />�sf�� ��s ��cr`J�-�� <br />NO. � TVPE OF FlXTURE OR REM <br />WATE!� CLOSET <br />BATHTUB <br />LAVATORY (WASH BASI�) <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 n'PE OF FlXTURE pR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIflEPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiRECT. ALL <br />PiiOVISIONS OP LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CON�TRUCTION OR i HE PERFORMANCE OF CONSTFUCTION. TFIAT I AM AUTHORIZED BY THE <br />OWNER OF TH�RO�ERTY TO PERFOjjM�fHE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�d ��C./ � <br />