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SITE ADDRESS <br />� f 3 �zc� �J . L <br />LEGAL LOT NO. <br />RERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S'TREET, EVERETT, WA 98201 <br />425-257-P.810 - FAX 425-257-8857 <br />BLOCK <br />R o ��c-� r S ��-�. <br />TENANTNAME <br />PPRCEL TA% I.D. p <br />TRACT <br />CONTACTNAME <br />w . L,Rr3 �e�.s � <br />PERMIT � <br />rno� <br />PHONE <br />s- <br />g� £ ��!r-,n �t>rOF-a3J/� C�Fys� s�� -a l t� � <br />CONTRACTOR qDDRESS ZIP CONTR. LICENSE k <br />N� C�/�LOr`d sE.,zv���S ca ��a � y�� <br />PHONE <br />s �cr-� � � �- q � � � /-ful� N� L949ai+ <br />PROPOSED USE OF BUILDING <br />S ��R , <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�iNS 3�4-C,L <br />PERMIT R <br />TYPE � <br />Building Mnchanical <br />Combination� F'lumbing <br />Demolition Sign <br />Sprinkler (a ol heads) <br />Addition HEATSOURCE <br />Alleration Electric <br />New Gas <br />Repair/Maint. Other <br />CIN OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />� ��Rn���� p�t�r��ak �- c�J � <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />SATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/MOP/ETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />N(: — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLUTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY fERITIfY THA71 HAVE READ AND EXAIdINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAlVS AND ORIDINACES GOVERNING THIS NPE OF WORK WII.L BE COMPLIED WITH WHETIIER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TQ VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICPI"ION IS MADE AND I COMPLY WITH TH[ STATE <br />COIJTRA(CT�L/kV 78.�� W AND 296.200 WAC. �/% �/ U 2 <br />/\, �-) <br />� �� \—�� I <br />