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P�.RMIT ApPLiCATII.�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, `NA 98201 <br />425-257-8810 - FAX 425 L57-8857 <br />13�Zo 3 -a � <br />SITE ADDRESS � PARCEL TAx I,R�1„ ___, �, ,_ � PF�iMIT k <br />�:U'� S.[. E.�G.PC7c�v <br />IEGAL LOT N0. <br />DESC. <br />OWNER <br />�Ob1n5cTn Pftl��r^Ti <br />TENANTNAME <br />LOCK I TRACT <br />AODRESS <br />$oo $.�. Evercn M�..�� <br />I CONTACTNAME <br />S��rE A� <br />� <br />PHONE <br />3S J-8400 <br />p4to -r►.c�.., Ciro,t.c�,r I oa...a Rob�ns.,,l �4z�) ss-3-4a4 0 0 <br />CONTRACTOR GI"I�FNEy c.9nlSTaIUCTJC�vADDRESS �O$�� I5� �Jc: S�C• Z�P CONTR.LICENSE# <br />srG c 5'AFFNCzv4K3 <br />PHONE�Q�LS% 33�-a\Iq <br />PROPOSEO USE OF BUILDING <br />� ,�(! ��.���� <br />CONTRACT FRICE OF WORK <br />PERMIT <br />TYPE <br />�.,�T� WA 90zo a <br />Building <br />Combination <br />Demalillon <br />Sprinkler <br />RMechanicai <br />Plumbing <br />D Sign <br />Addilion HEAT SOURCE <br />WORK R Alterallon D Electric <br />TYPE � New D Gas <br />RepaidMaint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />WORKDESCRIPTION�s� -�p0 2BirTH2ot�^S t (,���Sl�b Wf}�C '�"m�L`'��i'`S. <br />NO. � TYPE OF FIXTURE 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 />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENTER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />_ OTHER _ <br />NO. I T'PE OF FIXTURE OR ITEM <br />A!C -A/HANDUMG UNITS <br />FORCED AIR SYSTEMS . <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACFJSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CEPITIFY THAT I HP.VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE T(iUE 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 PERPAIT OOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOAMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER GF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CODiYRACTORS LAW 18.27 RCW AND 296200 WAC. <br />2 Z N1.1 LDi. <br />��2 <br />