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SITE GADDRtE^SS <br />O 2 c1 ^i <br />LEGA LOT NO. <br />:s <br />TENANTNAME <br />P�r�MIT APPLICATIO�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />ST <br />BLOCK <br />PARCEL TAX I.D. # <br />�2 -O��'DOO -D <br />7RACT <br />PERMIT k <br />Z <br />--�r 3��� c���, � �� q�2o� 42s=3o3--I� 2 1 <br />CONTACT FOR PERMIT <br />�,4-�ec�,� ircr��-��c <br />CONTRACTOR A�DRESS <br />����e,�f �1vus�.�9 ,C}�;.tnv.-�y <br />PHONE <br />4 2 S = �o�- �'.s"" <br />PHONE <br />%2S-S-d �- �'S-�`r 2 <br />ZIP CONTR. LICENSE # <br />3cu7 C��y,��•� 982�/ <br />PROPOSED USE OF BUILDING Building [� Mechanical I Addition HEAT SOURCE <br />PEF�"�T � Combinalion I) Plumbing WORK �Alteration (� Electric <br />TYP�E DemOliliOn D Sign TYPE New Gas <br />C��'� Sprinklef RepaiUMaint. Other <br />COIJTRACT PRICE OF WORK � nC O. v O CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />7 <br />WORK OESCRIPTION <br />�cs-f�,Ct/r���r�odE'� ���s�-ir�� C'Si C�G2nc'� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LP.UNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAF/MOP/ETC.) <br />NO. I TYPE OF FIXTURE OR REM <br />/ <br />� <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVF READ AND EXAMINED THIS APPLICATION AND KIJOW THE SAME TO BE TFUE AND CORRECT. ALL <br />PROVISIONS OF L1W5 AND ORIDINACES GOVEflNING THIS T1'PE OF WORK WILL BE COMPLIED WITfi WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUThIORITY TO VIOLATE OR CANCEL THE PROVISION Or ANY OTHER <br />STATE OR LOCAL LAW REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THF <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK rOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 18.27 RCW ANO 296200 WAC. <br />%- /� - � 00'7 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />