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SITE ADDRESS <br />� .y_ �� L � ,.: ,� � tii <br />I FGA LOT NO. <br />��Q1� 11 �j uS it� <br />TENANT NAME <br />S�m� <br />CONTRACT <br />� ��e�- <br />PHONE <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PAFCEL TAX �.D. # <br />;C1-nnl- <br />BLOCK � TRACT <br />. 3�o�-Cfllb � �,g�o <br />CONTACTNAME � <br />( i 1 � � L-C� � 1�.1� '� <br />`1 /� ADORESS <br />[lc�.U�,JG�'I�f�'� �jIJ4C�JI�H <br />7nc`! I � <br />`��5 `3�.5-Ila-� <br />PROPOSED USE OF BUILDING I <br />5�� <br />CONTRACT PRICE OF WORK � D <br />3 -�i-o�f <br />�a�3 G3 (� <br />���-s -3�3r��al <br />PHONE <br />�(7-S -��,��-��4' <br />LP CONTR. LICENSE # <br />�4��1 <br />��,��s=�-�-�-t� / — i3� // <br />n Building echanic <br />PERMIT [� Combination PlUmbing <br />TYaE Demolition Sign <br />Sprinkler (a ot heads) <br />W/�ORK DESCRIP(T}I,O_N �/ <br />K2(��RJ�`'Ylcr'L�G/i�'1�' paC�)Tlrt� K.S�C�s.+^e%L� <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET (TOILEf) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN 51NK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINh (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Adtlition <br />teration <br />New <br />Repair/Maint. <br />HEATSOUFCE <br />Etectnc <br />as <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />�_ RANGE HOOD <br />� WATER FfEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />�GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AIJD CORRECT. ALL <br />PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COh1PLIED WITH WFi�HER SPECIFIED HEREIN O(i <br />NOT. TI1E GRANTING Or A PERMIT DOES NOT PRESUh1E TO GIVE AUTHOFiITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOflIZED BY THE <br />01^JNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />