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� ERMIT APPLIc:AT`��N <br />CITY OF E`JERETT PERMIT ScRVlCES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425 �257-8857 <br />SITE ADDRESS <br />(a o 5 L'.., de � <br />LEGA LOT NO. BLOCK <br />DESC. <br />OWNER <br />� �+ ������� <br />TENANTNAME <br />� � <br />CONTRACTOR ` � � <br />G <br />PHONE <br />ppOPOSEO USE OF BU�LDING <br />PERMIT <br />� µP�'�'X TYPE <br />CONTRACT PRICE OF WORK'� �'7f (j . O O <br />TRACT <br />PARCEL TAX I.D. ti <br />a�-oo�-c <br />�o�-Co�6 <br />7T NAhSE <br />a �3� <br />3 � �, L. L R/J Cn � b�-� <br />ADDpESS <br />PERMIT k <br />yVl oa�� -oz8- <br />`�1�� 303 -�/0 3 <br />PHONE <br />L� e�%J ' 1a �'.��Ca l. � <br />21p CONTR. LICENSE N <br />Building �-kiechanical I j� Addiiion I HEc.7 souace <br />Combinalion � �� Plumbing WORKr•g�Alleraiion Electric <br />Demolilion � Sign TYPE �) New 5 <br />Sprinkler � Repair/MainL Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DE':iCRIPTION A_ � /p�Q/�A{+•-yQ 'PK•S <br />�u�- <br />NO. I TYPE OF FIXTURE JR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />3HOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUN�RY TRAY <br />CLOTHES WASHEF <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOA DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />ryp, I TYpE OF FIXTURE OR ITEM <br />�_ <br />� <br />A/C -A�HANDLING UNITS <br />FORCED AIF SYSTEMS <br />HEATPUMP <br />UNIT HEATERS � <br />CLOTHES DRYER t�-Q��'�' <br />RANGE HOOD Ra,pl�-J+-- <br />WATERHEATER (1�y�4r�� <br />METAL FINEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEnEBV CEfiITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAIdE TO BE TRUE AND CORREGT. Al� <br />PIiGVISIONS OF L1WS A�iD OFlIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIE� WITH WHETHEP SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PEPMIT DOES NOT PRESUME f0 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW FEGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TH� <br />OWNER OF THIS PROPEPN TO PERFORM THE LVORK FOR WHICH APPLICATION IS h1A0E AND I COMFLY WITH THE STATE <br />CONTRACTORS LAW 18.27 FCW AND 296.200 WAC. <br />(I,�Q_ ,,,� �I�-,IU2,. <br />