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P�r�MIT APPLI�ATIC��.J <br />CITY QF EVERETT PERMIT SERV�CES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />LOT NO. <br />L�i/isAY /1aa�% j Go <br />PHONE <br />'_7t�1 � <br />PROPOSED USE OF BUIL�ING <br />/ �F� <br />� S�i,/�ur..p <br />PARCEL TAX I.D. # <br />bo3R �boaoc <br />TRACT <br />ICONTACTNAME <br />�r,��r-�_� <br />ADDRESS <br />iiiq ��9y`Av-� S� b'v�r�l �P�-as� <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK 3� p D. vQ <br />Building <br />Combination <br />Demolilion <br />Sprinkler <br />WORK DESCRIPT N r <br />�-GY�D�" o� Y,�S��/ql,�G� <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />DRINK�NG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />RMechanical <br />Plumbing <br />D Sign <br />PERMIT R <br />Boza4-o�7 <br />ZIP PHONE <br />-a-rr3 Y� -�� 3 1373 <br />PHONE <br />LP CONTR. LICENSE M <br />LG�s�Y G�5'( G(i' <br />Addilion <br />WORK Alreration <br />l'YPE New <br />RepaiqMainl. <br />HEAT SOUFiCE <br />Electric <br />Ges <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ _ HEAT PUMP <br />� 1NIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERI' <br />_ GAS F!REPLACE <br />GAS RANGE <br />GAS PIPING <br />_ EXHAUSTFAN <br />GTHER <br />� <br />� I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNqW THE SAME TO BE TRUE AIJD CORRECT. ALL <br />i PROVISIONS OF LAWS AND ORIDINACES GOVFRNING THIS TYPE OF WORK WILL BF° COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />, NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITY TO 410LATE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCT�ION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFOFM JHE WORK FOF WHICH APPLICATION I;i MADE AND I COMPLY WITH THE STATE <br />CONTRyCTOFS LAW 18.�7 M�G-V�! AryQ 29�a(lO INAC. n � <br />