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� <br />PERMIT APPLiCATION <br />CITY OF EVERETT PERi��IIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITF ADDRESS ��� �v4 <br />� <br />LEGA LOTNO. �� <br />DESC. <br />OWNER <br />��oore _ <br />TENANTNAME <br />rv ,i <br />CONTRACTOR <br />�u ro rc� <br />PHONEQM ([�� <br />�`^� � !t�-� '� � � <br />PROPOSEO USE OF BUILDING <br />����e- ��c���J�im <br />CONTRACT PRICE OF WORK 71' <br />WORK DESCRIPTION <br />���1� o�+b�;l�''� <br />P�umsir <br />NO. I TYPE OF FIXTURE OR ITEM <br />�,( _ PARCEL TAX I.D. # <br />tfUi'��lM� ss a- 6 9-o i8-< <br />BLOCK T CT <br />1 eac� �-aw� o� <br />ADDRESS <br />_ g3a N�yr � <br />ICONTACT NAME <br />� � a%v'�e�r� <br />ADDRESS <br />' S 3 o-� �.s= 3ss-ya-3 � <br />_ WATER CLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ S110WER <br />KITCHEN SINK & DISPOSAL <br />DISHWFlSHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />GRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SE�VICE/BAR/MOP/ETC.) <br />_ OTNCR <br />Building Mechanical <br />aeRMIT � Combination R Plumbing <br />TYPE Demolition � Sign <br />Sprinkler <br />PERMIT N <br />� c�da—o3 � <br />�4��' voL �o Pc sa <br />ZIP PHONE <br />8�oi yas-aS9-i3i3 <br />PHONE <br />Yas-3y3-����3 <br />ZIP CONTR. LICENSE R <br />Addilion <br />WORK Alteration <br />IYPE Now <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />� I CITY OF EVERER' LOCAL SALES TAX CODE IS 3105 <br />NO. � TYPE OF FIXTURE UR ITEM <br />A/G —A/HANULING UNITS <br />FORCED AIR SYSTGMS <br />HEAI'PUMP <br />UNIT HEATERS � <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE 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 />PROI'ISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE f,OMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GPANTIN OF A PERM1IIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCE� THE PROVISION OF ANY OTHER <br />57ATE R LOCAL I A E�ULATIN CO STRUCTION Ofl THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OW��F THIS PROP ^'O PE�R� THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO„ A TORS LAIN 18. W AND 61p00 WAC. <br />��g_ � � <br />