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SITE ADD�E S <br />�s�i � <br />LE NO. <br />DESC. <br />OWNER <br />aA S • '3��M,.,�T <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF Bl11LDING <br />CONTRACT PRICE OF WORK <br />SCRIPTIDN <br />�Et�Mli' APPLICAT�JN <br />CITY OF EVEHETT PERMIT SERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />:,u S�. <br />BLOCK TRACT <br />NORK DE <br />����/H; <br />(��r,�o�r qHd l'vec 5-:��,d�✓q <br />l <br />PARCEL TAX I.D. ff <br />�ss �%f� <br />I CONTACTNAME <br />s� • <br />ADCRESS <br />8uilding D Mechanical <br />PERMIT R Combinalion B Plumbing <br />TYPE D Demolition Sign <br />�, Sprinkier <br />�Qf l/HPi �(y01« <br />S-�o vaf <br />� PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEA <br />KITCHEN SINK & DISPOSAL <br />D�SHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DFAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEJBAR/MOPlETC.) <br />OTHER <br />P MIT # <br />D�l�-��: <br />ZIP PHONE <br />%ao3 5'zssv7 yz�+ <br />PHONE <br />ZIP CONTIi. LICENSE N <br />Addition <br />Alterallon <br />New <br />Aepair/Main1. <br />HEAT SOUFiCE <br />Elechic <br />X Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3 i05 <br />ZE'{i ./N�vf oN k%P.T/ QFf� �� �'��Of� � W(x% <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HAND�ING UNITS <br />FOIiCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <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 CERITIFY ?HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS IYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO `/IOLITE OR CANCEL THE PAOVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPER7Y TO PE(iFORM 7HE 1NORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br />CONTRACTORS I.AW 18.27 RCW AND 296200 WAC. <br />,�/i � __�--� 27 //e� 02� <br />