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SITE AOORESS�y'-j � <br />� L <br />LEGA l0T NO. <br />DESC. <br />� �,.� �zr t� � <br />TENANT NAME <br />i <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 />PARCEL TAX I.D. � <br />£� <br />BLOCK TRACT <br />AD�RESS <br />�uT,fo2� �y 3i�� C��e��l <br />I CONTACTNAME <br />CONTRACTOR Fl ADDRESS <br />��;�Tt- Hv�i,N� ,-�vriioa�� � <br />PHONE <br />`tzs -��1- S'�,� I <br />��, 1,�. i� <br />PERMIT # <br />1Vl oZ�2-�j'�� <br />ZIP PHONE <br />�'u e, e 11� `I }-j -S��—Sl�l., 1 <br />PHONE <br />ZIP CONTR. LICENSE d <br />PROPOSED USE OF BUILDING Building Mechanical � I� Addnion HEAT SOURCE <br />S�� PERMIT RI--( Combination" Plumbing WORK �{—�c' Alteralion Q Eiectric <br />TYPE �J Demolilion Sign TYPE �j tJew �,.j Gas <br />I U Sprinkler U Fepair!�daint. U Other <br />CONTFiACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />WORK DESCRIPTIUN � n � y <br />R2Mn�L<+� �O..Si�ny 9 VP��`(l�+` I <br />NO. � IYPE OF FIXTURE OR ITEM <br />WATER CIOSET <br />BATHTUB <br />LAVATURY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />6ACKFlOW PREVENTER <br />SINK (SEFVICE�BARlMOP/ETC.) <br />OTHER <br />i���ix.r.r_w�yv <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />AJC — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLr�CE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREB'r CERITIF'i THAT I HAVE RF1.D AND EXAtdINED THIS APPLICATION AN� KNO'N THE SAh1E TO BE TRUE AND CORFECT. ALL <br />PROVISIONS CF W6V5 F.ND ORIDINACES GOVERNING THIS TVPE Of WORK WILL BE COPdPLIED WITH WHETHEF SPECIFIED HEiiEIN OF <br />NOT. THE GRANTING OF A PEFMIT DOES NOT PFESU6fE TO GIVE AUTHORITY TO VIOL4TE OF CANCEL 7HE PROVISION OF ANY OTHER <br />STATe OR LOCAL LAW FEGULATING CONSTRUCTION OR THE FERFOP�dANCE OF CONSTFUCTION. THAT I AM AU7HOPIZED 8V THE <br />O�VNER OF THIS PFOPERT! TO PERFOqM11 THE WORK FOR WHICN APPUCATION IS MAQE AND I COMPLY `NITH THE STATE <br />CONTRACTOFS LAW i9.D FC'N AND 296.200 WAC. <br />ali�/oa <br />