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SITE ADDRESS <br />LEGA �OT NO. <br />TENANTNAME <br />( <br />PERMIT APPLiCATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEGFlR STREET, EVERETT, WA 98201 <br />425-257-8810 — F AX 425-257-8857 <br />PARCEL TAX I.D. q <br />�� � <br />BLOCK TRACT <br />ADOqESS <br />�T'� �' �.r�r���u� � � � �� i <br />/ I C TACT NAME <br />CONiRACTOR ADORES5 <br />J�� s s��z v�cF P�un�Si�� <br />PHONr: <br />PROPGSED USE OF BUIL�ING <br />CONTRACT PRICE OF WORK <br />/, <br />PHONE <br />3 y�� `r�� h�� `� J� CONTR. LICENSE q <br />Or7��s s��i�s� <br />�vve2eT ��7�/ <br />Building Mechanical <br />PERMIT R Com6ination � Plumbing <br />TYPE D Demolition Sign <br />�� Sprinkler <br />WORK DESCRIPTION • <br />,A-�--7�z �' � p �,��,- � � G <br />� a �e W �s {-�e r� <br />NO. I TYPE OF FIXTURE OF ITEtd <br />WA7ER CLOSET <br />� BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNORYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACV<FLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Adtlition I HEAT SOURCE <br />Alleration Flectric <br />New � Gas <br />Repair/Maint. �� Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�R �� �� «�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYST[MS <br />HEAT PUM,P <br />UNIT H[ATERS <br />CLOTHES DRYER <br />P.ANGE HOOD <br />WATER HEATER <br />METAL � IREPLACE/STOVE <br />FIREFLACE INSEFT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVE READ ANG EXAMINED THIS APPLICATION AND K�OW THE SAME TO 6E TRUE AND CORflECT. ALL <br />PROVISIONS CF LAWS AN� ORIDItJACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIpLATE OFi CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW FEGULATING CONSTPUCTION OR THE PERFORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZCD BY THE <br />O�VNEii OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I CCMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />� '"' � _ Q L <br />