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SITE ADDRESS <br />� V <br />LEGA LOT NO. <br />TENANTNAME <br />�%%L,�,! L � <br />CONTRACTOR � --?. r <br />v �' <br />PHONE , i _, _ �, i <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF <br />�'ERMIT APPLICAT��N <br />C�TY OF EVERE7T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. # <br />PERMIT N <br />X Ga ia-o�3 <br />:SS ZIP PHONE <br />CO,N�T `CTNAME <br />� �.�,�r�r y(�/z" �/�� /��� 5�..� �f,� <br />rv�� ar��� A��os� �03 ;�h �c �v� z�P <br />���/c— �2ysa�l/. w,�- 9��0 <br />� Building Mechanical <br />PERMIT Combinalion � Plumbing <br />TYPE Demolilion Sign <br />Sprinkier <br />PHONE <br />CONTR. LICENSE p <br />J�'r/'LL' Dri,7-G <br />�Addition <br />Alteralion <br />New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Ges <br />Olhe� <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />WORKDESCRIPTION j,��,��� „� _j u�T/ Cr�����,eT �[yi� 9� Ls�t—S <br />�.t +` �1 777 l ✓ �/ <br />� !i�/vQ7Y,ln %Gl.s �!� �����/ /� �e?//7 GC%�o t.0 se. TGw � <br />��� I?/ C /d1 Q GGt /!� <br />N0. � TYPE OF FIXTUflE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN S�NK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />S�NK (SERVICE/BAR/MOP/ErC.) <br />OTHER <br />N0. I TYFE OF FIXTURE OR ITEM <br />_ A/c —a/HANDUNU UNITS <br />_ FORCED Alfl 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 AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNIhG THIS T'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TH[ GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROViSION OF ANY OTHER <br />STATE OR I.00AL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEFi OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SignaWre oi OwnedConlractor/Aulhorized Agent Date <br />