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� <br />� <br />SITE ADDRESS <br />�o S �- � <br />LEGA LOT NO. <br />DESC. <br />P�MIi APPLICATI�I <br />CITY aF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK � TRACT <br />PARCEL TAX I.D. # <br />Ut117 <br />.r'/r;;. ,�J <br />TENAN7NAME ' � CONTACTNAME pHONE <br />7�'raal !s� ��' I•�S s'� �,e �r �� 999 309� <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE k <br />w�- 9�p o3 <br />PHONE / ,�,,;�� <br />�'O� � — ? o %st �'%d°-� �1/L/f�� '�.$' F�✓��Y•�S'Co.f/ O 33� <br />PROPOSED USE OF BUILOING <br />1 \�S�ur� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR REM <br />WATER CI.OSET <br />BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />_ LAUNDRY TFIAY <br />_ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_�, FLOOR DRAIN <br />! BACKFLOW PREVENTER <br />� SINK (SERVICE/BAWMOP/ETC.) <br />_ OTHER <br />Building Mechanical <br />PERMIT B Combination Plumbing <br />TYPE D Demolilion Sign <br />U Sprinkler <br />Additiorf I HEATSOURCE <br />Alleralfon � Electric <br />New Gas <br />Repair/MainL Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. � 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 />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 T� BE TRUE AND CORRECT. ALL <br />PFiOVISIONS 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 REGUUITING CONSTRUCTION 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 RCW AND 296.200 WAC. <br />�d �� Z <br />