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� ERMIT APPLICAT��JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-3857 <br />LEGALJ LOT N0. <br />DESC.� �, / • <br />/ <br />OWNER <br />� u«✓� � S <br />TENANTNAME <br />D�es��,�� <br />I I F1A1:1 UF1 �'t � <br />�1^Sa7 �c��ri'iX�tl��'1 ��x. <br />� 7� -. <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />, <br />/7�/.V l�Un� <br />PARCEL TAX I.D. N <br />J - OD'-/ - O�(o <br />RACT <br />lat o-� ��n efic, <br />A�OFiESS <br />�/a 7s �' S-�� Sc <br />CONTACTNAME <br />/�4k� � �ow�'7`�" <br />ADDRESS <br />/8S p 1,3a /�cv:.1 <br />Po-�l,-� i� <br />Building Mechanical <br />PERMIT � Combinalion � Plumbing <br />7vPE Demolitian Sign <br />Sprinkler <br />D U PY �'� ��i c e— <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />_ LAVATORY (NJASH BASIN) <br />_ SHOWER <br />KITCIiEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAFUMOP/ETC.) <br />OTHER <br />PEHMIT k <br />(3oa� ; -oS c� <br />) 3S j-6S3 <br />j�� ZIP CONTR. LICENSE N <br />» Pe�ercclo2aLL, <br />qBo/a <br />Addition HEAT SOURCE <br />WORK Alteration n Electric <br />TYPE New H Gas <br />(iepair/Mainl. ,,, ILS� Qlher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />NO. � TYpE OF FIXTURE OR ITEM <br />/vt, —A/MANULING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIFEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIO�S OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILf. BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DO'cS NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCT;ON. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERIY TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO C RS LAW 1827gg W AND 296.200 WAC. <br />(�` '�GG�I ����-y�� %/�G�� <br />Signalure ol Owner/ConlractodAulhorized Agenl a�— � <br />IL <br />