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SITE ADDRESS <br />� p D SIF� <br />LEGAI LOT NO. <br />TENANT NAME <br />P�RMIT A��PLICATIO�d <br />CITY OF EVERE"�1" PERMIT SERVICES <br />3200 CEDAR STRF_ET, EVERE7T, WA 98201 <br />425-257-881 U — FAX 425-257-8857 <br />� 6 l oS <br />� v r r�abl W <br />BLOCK TRACT <br />�'��nspy� 1"���w-�,''�g <br />� <br />CONTRACTOR , 1-1 ! �' N DS I�� <br />/' /�l 0 u� �i rr <br />PHONE (�4 f 3 s� —� �` <br />� � <br />PROPOSED USE OF BUILDING <br />� <br />PARCEL TAX i.Q. # <br />A2Sr053.1 <br />s� su� N1,�14 <br />CONTACT FOR PERMIT <br />nl u�G ��� <br />ADDRtSS <br />PERMI? # <br />4)20�' <br />�{zs3s38�ao <br />PHONE <br />(z-�b) 3 s�( -89/z <br />ZIP CONTR. LICENSE # <br />46 2d ��(`=` Rv. sw � y�o� y� snin 9 <br />s� wk <br />� Building �I <br />PERMI'� Combinalion un <br />7YPE Demalilion Sign <br />Sprinkler <br />Addition I HEAT SOURCE <br />ration R E�leUric <br />New �y'Gas <br />RepaidMainL L� Other <br />CONTRACT PRICE OF WORK CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />� ( �+�,wloLvy. ^� �'.a t ij� �h9 <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER /�c� w��-w Inw,�-�{� <br />� Ce, „�..a�l..w <br />NO. .I TYPE OF FIXTURE 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 />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS R.4NGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER STOCIL �0� ado�QA's <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING STRUCTION R THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PB0 TY T �E K F R WHICH APPLIC/\TION IS MADE AND I COMPLY WITH THE STATE <br />�EBIT & CREDIT CARDS ARE NOT ACCEPTED <br />