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SITE pDDRESS ? 7 2 e <br />rT v�.� wA <br />LEGq LOTNQ <br />NAME <br />CONTRACTOR <br />S�, � i�� �c,vJ'1r v,-na v <br />vz5)� �3 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />/-Funi�v v/j <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT <br />PERMIT tl <br />YYlo3ni- <br />5�,�� � ADDRESS ZIP PHONF. <br />CONTACTNAME <br />AD�RESS <br />iL• f27-7-/f p/'. S.E. <br /><-'vC,.t-rr, w�. %�'za�� <br />_ zS96 <br />PHONE <br />ZIP CONTR. LICENSE Jf <br />c -' S'S - �`+ / <br />PROPOSED USE OF BUIL�ING Building � Mech•dnical Addition HEAT SOURCE <br />PERMIT R Comhination Plumbing �YORK � Alt?�ation � Electric <br />TYPE D Demoli�i0n Sign TYPE New Gas <br />D Spnnkler (a ol heads) Repair/MainL Other <br />CONTRACT PRICE OF WORK CITY OF EVERETf LOCAL SALES TAX CO�E IS 3105 <br />WORK DESCRIPTION <br />lv�l ��� ld-ivFlC�i l�C i�<..fL1S�iE.v� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TJILET) <br />BATHTUB <br />LAVATOFiY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I'fYPE OF FIXTURE OR ITEM <br />/ <br />A/C - A/HANDLING UNITS <br />FOfiCED AIR SYSTEMS <br />HEAT PUMP <br />I1NIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER__ <br />I HEREBY CERITIFY THAT I HAVE READ AND E;:P.MINED THIS APPLICATION AND KNOW THE SP.61E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAINS AND ORIDINACES GOVERNING THIS NPE OF IYORK WILL �E COMPLIED WITH WHEf HER SPECIFIED HEREIN OR <br />NOT. THG GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIV� AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STF,TE CR LOCAL LAW REGULFlTING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORAI THE WORK FOR 1M1'HICH APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br />CONTF3AGTORS LAW 182i RpW AND 296.2�0 WAC. <br />2 3 .�1 ^� C � <br />