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P'ERMIT A,PPLICATION <br />CIT �' OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-88� 0 — FAX 4�5-257-8857 <br />SITE /tDDRESS <br />� LoIS l-flYn�rcj <br />L9T NO. � 840CK � TRiiCT <br />PARCEL TAX I.D. # <br />l( 2' 7? Q fi/'v� <br />PERMIT # <br />'Yl O 3D8-O / a. <br />�'e�v,v�i�. �2�,b�v�SQv,_3Cds l.s,�l�rc( -�18201 `-{2$'--33�j35'J� <br />T�NANT NANIE GONTAC7 FOR PERMIT I" " PHONE <br />��►'ta..� 2S 01.tJ �-�% I Cd2V�UlGc. �c���71�c1�1� ��Co 'Z�Z�� <br />CONTRAL'TOR ��� ADDRESS �^ � ZIP CONTR.UCEWSEp <br />PHONE �� \�'� ���� (� <br />2e�cp Z8Z <br />PROPOSEDUSEOFBUILDING ^ ii Building �echanic <br />PEttM1T K Combin�tion lumbing <br />` 7YPE �_�� Demalitlon Sign <br />� LJ Sprinkler <br />LONTRACT PRICE OF WORK <br />!'YORK <br />�iSlQ�l ��l-IIC-;J'qga� <br />�jjj''''''))) Addition HEATSOURCE <br />aleratlon D ElecVic <br />New j$"�� <br />RepatrlMafnt. l_3 Othrs <br />CIN tlF EVERETT LOCAL SALES TAX COUE IS 9105 <br />�Pns'-�� � ��v��� <br />��� � t����vay`-to <br />NO. I TYPE OF FUCTURE OR ITEM <br />WATcR CLOSET (i OILE'n <br />BATtiTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITChIEN SINK 8 DISPOSAL <br />DISHP�ASHER <br />LAUNURYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR Df2AIN <br />BACKFLOW PREVENTER <br />SINK (S�RVICFJBARINi0P/ETC.) <br />GTHER <br />NO. I TYPE OF FlXTURE OR ITEM <br />A/l:-AlFtANULINCi UNITS <br />FORCE� AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS' <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY TH4T I HAVE REAO AND FjWMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WRN WHETHER SPECIFIED HEREIN OR <br />NOT. THE GR4NTING OF A PERMIT DOES NOT PRESUME TO OIVE AUTHORITY TO VIOIATE OR CANCEL TNE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW RE6ULATING COhSTRl1CTI0N OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK fOR WHICH APPIiCATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAnC TORS LAW 27 RCW AND 296.200 WAC. n, <br />( / E� �4 �M�i !(J ✓ i L��-l� I /� �� " ( ��C�� <br />DEBIT & CREDIT C4RDS ARE N�T ACCEPTED <br />�•d tsae�sz_a�•r.o! :woa� titi:sz �eaz-ei-srro <br />