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F��RMIT APPLICATI�.N <br />CI�Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT p <br />�07 �'(.� �(ieir�-T A'/q-fi w y I��o�G 6—GC� 3 <br />LEGA LOT NO. BLOCK TRACT <br />OESC. <br />,�oD��rr� <br />�nPe2 �i�s <br />TENANTNAME <br />.89-;� �i9-�1 <br />coNraacroa <br />PHONE ��J�/�SD� <br />PROPOSED USE OF BUILDING <br />�.UrvlryHl.l YMIOCUh WOF�K <br />�Lu�o��ts <br />� � �%t�l� t.t/iy ;� <br />CONTACTNAME <br />�.e� �E C <br />ADDRESS <br />�g3 <br />Building Mechanical <br />aERM17 R Combination � Plumbing <br />TYPE D Demolilion Sign <br />U Sprinkler <br />WORK DESCRIPTION <br />�Lu�wQiiS �'0�2 ��:`� G/�/k <br />NO. � TYPE OF FIXTURE OR REM <br />L(� WATER CLOSEI' <br />� BATHTUB <br />�� LAVATORY (WASH BASIN) <br />SHOWER <br />; �,� KITCHEN SINI( 8 DISPOSAL <br />I/ DISHWASHER <br />�� LAUNDRY TRAY <br />i � CLOTHES WASHER <br />URINAL <br />i� DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />i _ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />��1'ZoI' 3,�.7^ 8'S�ad <br />PHONE <br />`f zT �s'�- �9l s� <br />ZIP CONTR. LICENSE N <br />�Addition HEATSOUFiCE <br />Alleration Electric <br />New Gas <br />RepaidMaint. Olher <br />CITY OF EVERE7T LOCAL SALES TAX CO�E IS 3105 <br />NO. � TYPE OF PIXTURE OR 17EM <br />A/C — A/HANDLING UNITS <br />FORCED AIR 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 CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO 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 OTHEii <br />S7ATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WGRK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />Signature of OwnedContractodAuthorized Agent Date <br />