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i-�ERMIT APPLICAT_ ��1 <br />CITY OF EVERETT PERMIT SERVlCES <br />3200 CEDAR STRE�T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />ALiDRESS <br />LEGA LOT N0. / <br />DESC. <br />OWNER <br />� 5� ��� ���N � , <br />TENANTNAME !' � <br />� <br />CONTRACTOfl <br />PHONE <br />PARCEL TAX I.D. # <br />BLOCK TRACT <br />ADDRESS Z�P <br />c/ 733/ Be u, R/� -�'i��o <br />� CONTACTNAME ` <br />-rrc�,- �TC� �t Cy- � e i H�C P <br />AD�RESS Z�P <br />P��jiED'U�EQF_B;I��N�G1 PERMIT <br />� S� � � t J TYPE <br />� <br />. �, :�5e e � <br />CONTRACT PRICE OF WORK �� <br />WORK DESCRIPTION <br />UtiC^�P G'�C'C. H/eZT'P/ %lPR�P/ <br />/-11so �L�..�e /o�Q�,�., <br />NO. � TYPE GF FIXTURE OR ITEM <br />WATER CLOSET <br />BAiHTUB <br />LAVATORY (WASH BASIN) <br />SHOW[R <br />KI7CV iEN SINK & DISPOSAL <br />DISYiWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICFiBAR�MOP/ETC.) <br />OTHER <br />PEflM1T 4 <br />r11�a�r-oi5 <br />PHONE <br />�l�s5y7is3 <br />PHONE <br />�.5 - �1�2 3ioa <br />CONTfl. LICENSE d <br />!� Building � Mechanical Additiun HEAT SOURCE <br />�—� Com6inalion Plunbing WORK R Anaration [� Electric <br />G� Demolilion Sign TYPE R New Gas <br />U Sprinkler V Repaidldaim. B Other <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />-�o �45. / <br />qC .�r.le�.- -��re flous'e f�o por�h, <br />vo.�+ u <br />�O. I TYPE UF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />_ UNIT HEATERS <br />CLOTHES DRYER <br />FAhGEHOOD ' <br />� WATER HEATER L 1e�"'"'c noK/qo �� <br />��tETAL FIREPLACE/STOVE �ras. <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />_ EXHAUSTFAN <br />OTHER <br />I HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS CF LAWS AND OFIDINACES GOVERNING THIS NPE OF'NORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PFRP.IIT DOES NOT PRESUME TO GIVE AUTHORITf TO VIQLITE OR CANCEL THE PROVISION OF ANY OIHER <br />STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />CWNER OF THIS FROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIGN IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA 1,89 27 RCW ND 29 .200 WAC. <br />/] 1_„ �•�,tiU� fwi�C'✓ Il/�7-/c�Z <br />�' \ Q��l —� `� <br />