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, _ <br />PE��MIT APPLICA"TIO��� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 5TREET, EVEREl'r, WA 9t320' <br />425-257-881U - FAX 425-257-8857 <br />SITE ADDRESS <br />(� O s �- [�vt�Qc-t^ <br />LEGAL LOT NO. BLOCK <br />DESC. <br />�.��-�-t-�- , <br />TENANTNAME <br />CONTRACTOR <br />��/trjC S <br />PHONE <br /><F 2 <br />PARCEL TAX I.D. li <br />TRACT <br />"�'' S �'"`� <br />�AME <br />� ��'- V ( L �- �C1/U� JfADDRESS <br />3��1 K2o�e�l�-P <br />�� - 25�'-�`r�$D <br />�ROPOSED USE OF BUILDING <br />PEqM1T <br />TYPE <br />CONTRACT PRICE OF WOflK <br />WORK �ESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CIOSET <br />� BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />L KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBARJMOP/ETC.) <br />Building <br />Combinalion <br />Demolition <br />Sprinkler <br />�Mechanical <br />Plumbing <br />Sign <br />a <br />PHONE <br />� • Oo� <br />ZIP CONTR. LICENSE N <br />9���( <br />�9�v E5 S /" / <br />���]]] Addition <br />RK � Alteralion <br />�E New <br />Repair/Maint. <br />"v li <br />HEATSOURCE <br />�Eleciric <br />Gas <br />Ofher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />NO. I TYPE UF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT 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 />EXHAUSTFAN <br />I HEREBY CERITIFY'HAT I HAVE REAU AND EXAMINEr� 7HIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL <br />PROVISIONS OF LAVvo' AND ORIDINACES GOVERNING HIS IYPE OF YJOflK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TH[ GFAN7ING OF A PERMIT DOES NOT PRESUiv1E TO GIVE AUTHORI iY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORh1 THE'NOFK FOR WHICN APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 2962C0 WAC. <br />_. � ��''C ����,1,�2a�'!� _ _ `�'�' � � <br />