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� <br />,, �-- <br />�i �`�y�" <br />P��,�MIT APPLICATIG�J <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREn, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� SITE ADORESS <br />; �i <br />LEGAL L0T N,/O. <br />DESC.r �� 4, ���� <br />O\YNER . <br />l�'1C�1//ti � <br />TENANT NAh1E <br />'GR!% �JCc iG+/ti�P <br />I CONTRACTOR �L . � <br />� <br />� PHONE f:/hG_ - <br />� �� <br />I PROPOSED USE OF BUILOING <br />', :�,Q��(�.C/�! <br />' PARCEL TAX I.D. k <br />I ��� � y 3� - <br />BLOCK , TRACT <br />ADDRESS <br />J /` <br />���uilding Mechanical <br />PEFMIT I) Combination R Plumbiny <br />TYPE C� Demolition � Sign <br />D Sprinkier <br />CONTRACT PR�CE OF WORK ej 1' D/_O Q y <br />(!� <br />', WORK DESCRIPTION <br />'t n��1 c <br />r�umdir <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BA7HTU� <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHV�'ASHER <br />LAU�DRYTRAY <br />CLOTHES WASHER <br />URII �AL <br />DRINK�NG FOUNTAIN <br />FLOOR OHAIN <br />BACKFLOW PREVENTER <br />_I SINK (SERVICFrBAFUMOP/ETC.) <br />D� <br />�� � ���f <br />,�,� / PERMIT # <br />� Z ��XYb 1i�26$-DI l <br />ZIP PHONE�/Z� <br />�f l,��Q 1X���/ 15 7- D/3 �: <br />PHONE <br />r �fz5 z57-v13�� <br />ZIP CONTR. L::.ENSE a <br />SCk/E.3/ !S 3c� � <br />Addition HEAT SOUFCE <br />VORK��Alteralion I � Electnc <br />YPE New Gas <br />— FepairRdaint. Other <br />CITY OF EVERET'f LOCAL SALES TAX CODE IS 3105 <br />N0. I TYPE OF FIl(TURE OR ITEM <br />A.'G - A/HANULING UNITS <br />F�>RCED AIR SYSTEMS <br />NcAT FUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSEFiT <br />_ GAS FIREPLACE <br />GP,S RANGE <br />_ GAS PIPING <br />EXHAUST FAN <br />._ OTHER <br />� <br />t HEREB'I CEr17iF{ ; HA'P I HAVE READ AND E?CA1dINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. P.LL <br />PRUVISIC��S ;= s':/S �ND CfiIGINACES GOVERNING THIS TYPE OF WOFK WILL BE COh1PLIFD WITH WHEfHER SPECIFIED HEREIN 6R <br />!10T THE GR?•,71hG CF A PERtd!T pOES NO' PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL ThE PROVISION OF ANY OTHER <br />S i ATE CR LGC%L'..n';! PEGUTATING CONSL � 1CTION OR THE PERFORPdACJCE OF CONSTRUCTION. THAT I AM1i Al77HORIZEU BY THE <br />OVJNER OF TYiS PFCPERT! TO PERFORM THE WORK FOR WHICH.4PPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br />COIJTRAC'GFS Ir' 7! !827iRCW ANO 29fi.200 WAC. <br />/ <br />� l�+;�, r�� L��C t � l- o�� � <br />Sigrtawre sl GvmenContractor/Authonaed Agent Dale � Z <br />