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SITE ADDRESS <br />70 / f.a,c.�er- <br />LEGA LOT NO. � <br />DESG. ) Q I <br />Sc �.c c <br />TENANT NAM17E <br />F�RMIT APPLICATII,iV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />'c,�c e �`�1- <br />BLOCK <br />�� <br />jc �� i <br />CONTRACTOR G�`� U•'� Wi'-�p�O�.0 %_ <br />PHON£ zo� qo2 I o�; b <br />PF'iOPOSED USE OF B1UILDING <br />� N � Ca\��'\ <br />S��Ku^o0+^'� <br />PARCEL TAX �.D. # <br />� OU <br />TRACT <br />n <br />�O ( �o u-'�-� ��a��C rD� <br />CONTACTNAME <br />s�� -'�1� <br />ADDRESS <br />I 8 Y 36 c�+sc�deowe <br />Buiiding Nechanical <br />PERMIT Combination Plumbing <br />TYPE � Dertiolition Sign <br />U Sprinkler <br />CONTRACT PRICE OF WORK /n nn � <br />WORK OESCRIPT�ON / / <br />��,r,( an %�-f-�M Suv�rcJ^J� <br />NO. � TYPE OF FIXTUHE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DI:iHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACI<FLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />9t'LZ03 �.�5-3y8�6 <br />PHONE <br />�6-zss-/73 / <br />ZIp CONTR. LICENSE p <br />so. q8i 8S cHAn��ucs�o8 -T <br />�Addilion <br />Alleralion <br />New <br />Repair/Maint. <br />HEATSOURCE <br />�D Electric <br />� D Gas <br />U Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <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 PIPIN�; <br />EXHAUST FAN <br />OTHER <br />I HEREBV CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRF_CT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1YPE OF WORK WILL BE COMPLIED WITH WHETHF.R SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOGAL LAW REGUTATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFLTY Tn PEFiFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT<��182� RC�IJAN Q6.200 WAC. <br />, <br />� S/.� 1� � <br />Signalure ot OwnedContraclodAuth ed Agent �a�e i/a <br />