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� <br />� <br />P�.r�MiT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 CLDAR STREET, EVERETT, WA 98201 <br />425-257• 8810 - FAX 425-257-8857 <br />SITE ADDRESS/, _ / <br />GS����7 (Xy�ri �t A�� <br />I.EGAL LQT NO. BLOCK <br />DESC. <br />��� Vi�,��,�1� <br />PARCEL TAX I.D. k P�Rr.tiT a <br />, >>i-lu�O15 vUtlO� ;�d,%�D;�a <br />TRACT <br />ADORESS LP PHONE�/l r J <br />'�la-- iU61 ' p� S%" Sn�����Y6 ��� 9�zv6 Y � <br />TENANTNAME � CONTACTNAME PHONE <br />CONTpACTOF � �L�'Sti'�% (,C�tf�. 'a' ADDFESFi �%,l� ��i�il fJ�• C ZIP CONTR.UCENSEM ' <br />PHONE Z���Iyy�13�7L ��cv�.�N,�fa /vN� 96�`i� r,�CG/�c��ac� <br />PROPOSED U�E OF BUILDING • <br />11-� � ti � � � � <br />CONTRACT PRICE OF WORK <br />!�j Buiiding Mechanical <br />PERMIT �j Combination R Plumbing <br />TYPE D Damolilion p Sign <br />U Sprinkler <br />Adtliiion NEAT SOURCE <br />WORK Alteration � Flectric <br />TYPE New Gas <br />FepairRdainL Other <br />CITY OF EVEREl7 LOCAL SALES TAX COOE IS 3105 <br />WORKDESCRIPTION f� _�iv O�� L��r4l�C.(� (,J/�,t� �lK� �%C(Sf G�1��J <br />r�-r_ p <br />NO. I TYPC OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEP <br />URINAL <br />DRINKING F(JUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFlEVENTER <br />SINK (SERVICE/BAR/MOPfE�iC.) <br />OTHER <br />NO. I TYPE OF FIXTUR'c OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WHTER HEA7ER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY 7HAT I HAVE READ AN� EXAMINED THIS APPUCPTION AND KNOW THE SAIdE TO BE TRUE AND CORRcCT. ALL <br />pqOVIS10N5 OF LAWS AND ORIDINACES GOVEANING iHIS TVPE OF NORK WILL BE COMPLIED WITH WHETHER SPECIFIF.D HEPEIN OF7 <br />NOT. THE GRANTING OF A PER'b11T DOES NOT PRESUAIE TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION UF ANY OTHER <br />STATE OR LOCAL LAW REGULPSING CONSTRUCTICN OA THE PERFOFAIANCE OF CONSTRUCTION. THAT I Ald AUTHORIZED BY THE <br />OWNEH OF TFjIS,QROPERIY TO�EfiFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATe <br />CONTRACTOii5iL;14V 18.27 RCW AND 2�6!Q00 WAC. <br />_ / l/—p i� <br />