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I <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />� `II-02 <br />SITE ADDRESS �'Z �/C �� S'� PARCEL TAX I.D. # PERMiT a <br />��-��; � ��a-- nt uu��2- /)20 <br />LOT NO. I BLOCK � TRACT <br />�1.�!�e� �uSw,� AuT�toQ��y 3,�-� ro�ay �.'vev'e� `���-j��—Sl�l., � <br />TENANT NAME I CONTACT NAME PHONE <br />CONTRACTOfl AD�RESS <br />���-rt t+��s,N� q,.�„oe,; y <br />PNONE —p Slc l� I <br />`1z5'� 1' <br />ZIP CONTR. LICENSE A <br />PROPOSEO USE OF BUILDING Building MeChaniCal Q- Addition HEAT SOURCE <br />S��� I PERMIT R Combinalion" Plumbing WORK �9-Altera�ion � Electric <br />TYPE D Demolilion Sign TYPE D New Gas <br />U Sprinkler U RepaiqMaint. Other <br />CONTRACT PRICE OF WORK �CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />WORKDESCqIPTION ,.� yIO�.S�+ty9Ve���4r4 <br />emo �SQ 1 � <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />D�SHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/htOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLWG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEF <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIP�NG <br />EXHAUSTFAN <br />I HEREBY CERITIFY THA71 HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF W WS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WFiETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEfl�d1T OOES NOT PqESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OF LOC.1L LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOPIZED BY TFiE <br />OWNER OF THIS PFOPERN TO PEFFORM THE WORK FOfl WHICH APPLICATION IS bIADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 1827 PCW AND 296200 WAC. <br />