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�� ERMIT APPLICAT�_ JI� <br />CITY OF EVE.�iETT PERMIT SERV!CES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS L�'I ( %C �If �R{ � �ij{/( � PARCEL TAX I.D. # <br />LOT NO. <br />� A. <br />J�.. Tc�a.�c <br />TENANT NAME <br />��ic_c_RfL .G1�5 c�,��, <br />CONTRACTOR �/���A�T <br />BLOCK I TRACT <br />ADURESS <br />CON7ACTNAME <br />.�r (��t�l�K ff��a�(1�c <br />ADDRESS <br />PHONE ��� 'ry� �/�� <br />f0�� <br />PROPOSED USE OF BUILDING <br />�!�(`,.r, t <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK �5-r i t g8e <br />�Building n Mechanical <br />Combination �'"S Piumbing <br />Demalilion � Sign <br />Sprinkler <br />WORKDESCRIPTION l n,�f �q� ��� �r <br />s) � dN �� � <br />�,� t� F,���s �dd �,.f ���`�.� <br />� ci�,,,.,,.. j,�F (9r'�..,�.,,.., <br />� <br />� NO. <br />i — <br />TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDFiY TRAY <br />CLOTHE.S WASHER 5 <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT # <br />� 'LIF PHONE <br />PHONE <br />`/�S S/3 � s <br />ZIP CONTR. LICENSE M <br />�Addilion <br />rxAlleraUon <br />� � New <br />LJ fiepai4Main1. <br />HEATSOURCE <br />Electric <br />Gas <br />Olhe� <br />CITY OF E4ERETT LOCAL SALES TA% COUE IS 3105 <br />d���,t< <�,�s�1 d���S <br />�..( 3�f -zf�ci-n-�'e,a.� <br />•{„ � ry-�-.�. t.��n_ c (F� � <br />NO. f TYPE OF FIXTURE OR ITEM <br />�3' <br />c...� �1-Nu..�l+� <br />c.'� � �. �JFLA <br />A/C – A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT FUMP <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 />I HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANQ ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DQES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRUVISION OF ANY OTHER <br />STATE 0A �LOCAL lAW REGULATING CONSTRUCTION OR THE PtRFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNERTaF THIS PROPERTY TO PERfqRM THE WORK FOR WHICH APPLICATION IS MADE AMD I COMPLY WITH THE STATE <br />� �3._ �2 <br />-- . - �- , . <br />Si al re of OwnedContrac or/Authorized nt Date <br />, �Iz <br />