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� <br />� <br />. ERMlT APPLICAT�JN <br />CITY OF EVERETT PERMIT SER1; ICES <br />3200 CEDAR STREET, EVERETT, WA 982G1 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDFESS <br />8�l `l I_ 1 K d.Q v� <br />LEGA LOT NO. BLOCK <br />DESC. ' <br />�iw-tv-i� 1{ovSlvt�� Ei�-�{rof.� <br />TENANT NA61E <br />CONTRACTOq �1� <br />�u�� fro.iSln� <br />PHONE AV-`I-Er�!'��`� <br />PROPOSED USE OF BUILDING <br />� �j, � P��x PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK '� .c�'10 , <br />J .r <br />PARCEL TAX I.D. X <br />1 `l < <br />TRACT <br />% � <br />a <br />3 iv� e�,lby �u-ere'fj- wa `lY1�l 3o3•Ifo3 <br />CONTACTNAME PHONE <br />3��� L<w�G,u..�— <br />ADDRESS <br />�8uilding <br />Combinalion <br />Demolitian <br />Sprinkler <br />WORK DESCRIPTION /, _ �G �/�Y ��,� �x���y� <br />�r�7i <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 />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAF/MOP/ETC.) <br />Plumbiny <br />Sign <br />`1Z-J -SoI-J C.�. I <br />ZIP CONTR. LICENSE N <br />�di�ion <br />eration <br />New <br />Repair/Maint. <br />H[ATSOURCE <br />Electric <br />as <br />Cther <br />CITY Oi- EVERETT LOCAL SALES TA% COOE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEAT[RS <br />CLOTHES ORYER �p�� � v`"'x <br />RANGEHOOD Rap1.-�-P <br />WATER HEATER 1�.2p1�< f. <br />METAL FIREPLACE/STOVE <br />FIREPLAC[ INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING i <br />EXHAUSTFAN <br />OTHER <br />(� 71 <br />I HEREBV CERITIFY THAT I HA\+E READ AND EXAh1WED THIS APPLICATIC�v AN� KNOW THE SAM11E TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND OiiIDINACES GOVERNING THIS NPE OF WCRK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OA <br />PIOT. THe GRANTING OF A?EPb11T DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLITE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOCdL LA�N RFGUL;ITING CONSTi7UCTI0N OR THE PERFOR6IF NCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 7HE <br />OWNER OF THIS PROPERN TO PEFFORtvI THE'NORK FOR WHICH APPLIG4TION IS MADE AND I COMPLY WITH TNE STATE <br />CONTRAC70RS LAW 1827 qCW AND 296.200 WAC. <br />7// � /o <br />