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� <br />�� <br />SITE ADDRESS <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />i' 7 C� �i <br />TENANT NAME <br />PB jMIT APPLICATI�..; <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�0 4�• ���eo�- vL� 98.Z�3. <br />PARCEL TAX I.D. # <br />BLOCK I TRACT <br />l: V n I AG� IVAME <br />PERMIT N <br />CpLo & <br />PHONE <br />vwn� � <br />CONTRACTOq ADORESS LP CONTR.UCENSEM <br />PHONE <br />PflOPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />PERMIT B Combination R Plumbing <br />TYPE D Demolition p Sign <br />U Sprinkler <br />Addition <br />Alteralion <br />New <br />RepaiNMaint. <br />HEATSOURCE <br />Electric <br />Ges <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION <br />�� �%i�ne�i-�c,� �Pla�z w,n��s ,,,� u..�� a� <br />NO. � TYPE OF FlXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DPINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />3S <br />NO. � TYPE OF FlXTURE OR REM <br />_ Nc: —A/HANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />RANGE HOOD � S <br />� WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />_ EXHAUST FAN <br />_ OTHER <br />I HEREBY CERITIFY'HAT I HAVE READ ANO EX.AMINED THIS APPLICATION AND KNOIV THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVIS�ONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GPANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PfiOVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTFUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF 7HIS PROPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACiORS LAW 18.27 RCW AND 296.200 WAC. <br />02 <br />