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� <br />�� <br />SITE ADDRESS <br />bo7s�E <br />LEGA LOTNO. <br />TENANTNAME <br />F�RMIT APPLICATI�I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-6857 <br />i /rla�l. <br />BLOCK <br />s�c IF <br />5�b <br />I PAflCEL TAX I.D. # <br />� 18�8os-3-oyo-a <br />TRACT <br />2f3�1 -(zSE <br />ADDRESS <br />T Win��CJ���A'1 q8� <br />CONTACTNAME <br />PER N <br />�� <br />�lZS <br />PHONE <br />TN�� QROTNER$ � Vri:k� �Morec,u 360,650-��So <br />CONTRACTOR pDDRESS ZIP CONTR. LICENSE M <br />C�srov�n D�s�c� SIG� � AWN�WG N Z3 Kt�rv�,ry Si Cus i oD SoyZL(, <br />PHONE <br />GcLLi..iGlls��na w,a qszzs CosrvDs'o66�� <br />PROPOSED USE OF BUILDING BUilding � MeChanical Addition HEAT SOURCE <br />C— I PERMIT R Combination Plumhing WORK � Alleration (i Electric <br />TYPE D Defiolitlon Sign 7YPE New � Gas <br />CO IM N.( ER C � A I.. U Sprinkler RepaidMainl Olher <br />CONTqACT PRICE OF WORK � Ll�^Z � O O O CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK �ESCRIPTION <br />%1%FG��STALL. /�(C[.J c�EcrR�c.�� SI(a�I <br />NO. I TYPE OF FIXTUflE OR REM <br />_ WATER CLOSET <br />BATHTUB <br />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 />N0. � TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNI iS <br />FORCED AIF 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 />EXHAUST FAN <br />OTHER <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 WHEfHER 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 CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN 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 />S'�—O <br />