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�� <br />� <br />P�RMIT APPLICATI�C.V <br />CITY OF EVERETT PERMIT SERVICES �,�.�_o Z <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />Dl,+�n�U4--O <br />SITE ADORESS <br />_ y � �uc <br />LEGA LOT NO.'S' BLOCK <br />DESC. L „r <br />OWNER <br />S-i�uc-�r� �c�iZosQ <br />TENANTNAME <br />CONTRACTOR <br />PHONE � ��� <br />lN�� <br />pqOPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />CONTRACT PRICE 0� WORK � � � <br />PARCEL TAX I.D. � <br />I o�'4�75E��Soo600 i <br />TRACT pIV �I ' �C.AI o� 13L. $=� � <br />3y I 3 f Fo�'s'z9L RuE q$�bl <br />( CONTACTNAME <br />AOURESS ZIP <br />�uilding Mechanical <br />Combination � ?lumbing <br />Demo�ilion Sign <br />Sprinkler <br />>�aMir x _ <br />�FJ�U-� ' ��_ <br />��� <br />IONE <br />'Y�2S 339-a�'l� <br />PHONE <br />CONTR. LICENSE 1 <br />�Additian <br />Alteratlon <br />New <br />RepaidMaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OP EVERETT LOCAL SALES TA% CODE IS 3105 <br />WORKDESCRIP�ION n /lJ�1Ll � �•G �,n�nL�tC�v Q1Gu��yl5 �1�1C{S lyyt <br />F E'7ct1 ✓11n� <br />NO. I NPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />I.AUNDRY TFAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ET:.) <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 HEATERS <br />_ CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />_ OTHER <br />I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF fAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 6E COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PFOPEPIY TO PERFOrIM THE WORK FOR WHICH APPLICATION IS MADE AND I COMF�Y WITH THE STATE <br />rntiranr.TORS tAW-W:�27�CW.ANO 296.200 WAC. . <br />�//.E/�� <br />i <br />L- <br />