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SITE ADJRESS <br />��,5�< <br />LEGA LOT NO. <br />!Ct,� <br />ENAN7NAME <br />A J��:�a <br />P�RMIT APPLICATION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42.5-257-b810 - FAX 425-257-8857 <br />PARCEL TAX l.D. # <br />�G71� �� <br />BLOCK TRACT <br />P/,�ORESS <br />�> �GGGI 7-- � <br />I CONTACT FOR PERMIT <br />CONTRACTO � � U ADDRESS <br />Pt��� �'�`ti��� � � �J �-�,;���� <br />PROPOSED USE OF BUILDING <br />CONTftACT PRICE OF WORK <br />PHONE <br />-o <br />-- I <br />3.S�ii� � L� ��i1 ��'�•' ZIP CONTR� �� U SEl / <br />��r ;' �` !J 7 � <br />d�� � w� ��5�76 �.� <br />B�ilding Mechanical <br />PERMIT R Comb�nation � Piumbing <br />TYPE D Demo ition S�gn <br />U Sprink!�r <br />Addition HEATSOURCE <br />WORK Alte2von n Electric <br />TYPE New D Gas <br />Repair/lvfaint U Other <br />CIT`! OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK UESCRIP7'ION , � �.� n � _ � � � r,� � � (�I , �, , fJ C/ Gfi�-K - <br />� : l,,ll �L. „ <br />'�CJiJ �Vl�- 1.01 a lGtrfL(/7'/r1 <br />N�. <br />� <br />�_ <br />� <br />�I�L <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TCILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHNJASHFR <br />LAUNDRYTRNY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERU E/BARlMOP/ETC.) <br />OTHER S ��_ <br />NO. I TY('E OF FIXTURE OR ITEM <br />,4lC-NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT FIEATERS <br />CLOTHF.S DRYER <br />RA�GEHOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />i HEREBY CERITIFY THA"i I HAVE READ AND EXAM1�IINED THIS APPLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECT. ALL <br />aROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL Be COAIPLIED WITH WHETHER SPECIFIED f IEREIN OR <br />t�IOT. THE GRANTING OF A?ERMiT DOES NOT PRESUME TO GIVE AUTHOFITY TG VIOLATE OR CANCEL THE PROVISION OF FNY OTHcR <br />STATE OR LOCAL LFlYL' REGULATING CONSTRUCTION OR THE PERFORM1tANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW� lER OF THIS PROPERTY TO PERFORId THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STHTE <br />�CEPTED <br />