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� �ERMIT APPLICA : _ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />c�d �L������,:� s <br />LEGA LOT N0. BL CK <br />DESC. 8 (�j <br />OWNER <br />�N.�L ls� � LfL 12 i�3�� I-1-/ <br />TENANT NAME � <br />CONTRACTOR �� L,.^ <br />PHONE <br />PROPOSED USE OF BUILDING <br />-r�, -� <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # <br />. ��'.�`�t�3Z oo�- �g ov <br />��y Ni��s 7�i� <br />oo� r��Y�r»�NC� <br />,. i r .r- <br />CONTACTNAME <br />ADDRESS <br />Building Mechanical <br />PERMIT Combination Plumbing <br />TYPE � Demolition Sign <br />u Sprinkler <br />ZIP <br />il���-aZ <br />PER IT k <br />2// 6/ Z <br />uv��u �, 9� <br />PHONE <br />�G��31L-� <br />PHONE <br />CONTR. LICENSE k <br />Addition <br />WORK Alteration <br />TYPE New <br />f;epair/Maint. <br />NEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION � <br />.�I P f� 5� C ur.( rJ l= %(�o tC Y3 c�p 2� ow�I ,(j /3-T7-1 <br />IZCS l.r�L fi� L� G L� v� ��9-/�A cr L <br />�3� <br />N0. I 'rYPE OF FIXTURE OR ITEM <br />I WATER CLOSET <br />Z BATHTUB <br />_L 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 />NO. I TYPE OF FIXTUHE OR 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 FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE S%+ME TO BE TRUE AND CORtiECT. ALL <br />PROVISIONS OF LAV'!S AN� ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIPJG OF A PERMIT DOES NOT PRESUME TO G!VE AUTHURIIY TO VIOLP.TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGULATING COlvSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 BCW AND 29fi200 WAC. <br />