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SITE A�DRESS �j L <br />L <br />LEGA LOT NO. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SEFtUlCES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42545'-8810 — FAX 425-257-8857 <br />a � rJ <br />BLOCK � TRACT <br />PARCEL TAX I.D. # <br />PERIAIT # <br />�'�D a0 a-� <br />�'��i.e7f' �uSi�,C� �uTrfo2i�i .31v� C�o�C�iy �'ve�-e� `��i-��-S��-Sl�l., 1 <br />TENANTNAME I CONTACTNAME PHONE <br />CONTRACTOR A�ORESS <br />���7r Nv�„N� q..t��oe,; y <br />PHONE <br />`115'»I' Slo� 1 <br />P90POSED USE OF BUILOING <br />SF`Z <br />CONTRACT PRICE OF WORK <br />PERMIT <br />TYPE <br />I <br />�� <br />� <br />� <br />Building �Mechanical <br />Combination' Plumbing <br />Demolition Sign <br />Sprinkler <br />WORKDESCRIPTION 1 !� � y <br />2mn�X �OLLSi.n�9 Ve�``�-�r 1 <br />N0. I TYPE OF FIXTURE OR TEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDAY TRAY <br />CLOTHES WASHEa <br />URINAL <br />DRINKING 'rOUNTAIN <br />FLOOR DRAIN <br />BAC;Y.FLOW PREVENTER <br />SINK (SERVICE�BAWMOP/ETC.) <br />OTHER <br />ZIP CONTR. LICENSE : <br />n Atldilion <br />'�� Nlee��raliar� <br />U Fepair/Malnt. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVEREfT LOCAL SALES TAX COOE IS 3105 <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C — NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />FANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLAGE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREB'I CERITIFY'HAT I HAVE READ AND EXA�AINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L1WS ANO OFIDINACES GOVERNING THIS NPE OF WOFK WILL BE GOMPIIED WITN WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERPlIT OOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATe OR LOCAL lA`N REGULATING CONSTRUCTION OR THE PERFORRfANCE OF CONSTpUCTION. THAT I AM AUTHOPIZEU BY THE <br />OWNEF± OF THIS PROPER'Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COtdPLY WITH THE STATE <br />CONTRACTORS L1W 1827 RC'N AND 29fi200 WAC. <br />al��/oa <br />