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P��cRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR,STREET, EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS <br />:' �)- o Ni � l�l ��,,,> ��r tf; <br />�esc.�lc%-�o � `!J3 <br />OW NER �,,j� „�Z c N�l_` � ��/' �"ji r#/� l3'=/' 'I <br />N� y.'��; �f <br />TENANTNAME <br />CONTRACTOR�r���Ac��,��-� �. <br />PHONE �/ L i 1.�5 �'1 y, j G <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />PARCEL TAX I.D. R <br />TRACT G�/t -!F�/�'S S <br />ADDRESS <br />CONTACT NAME <br />ADDRESS <br />' i 7I. /-ff�7,r(,�r-R'/i�` <br />� c l;k'�"77- C��} 9 8 �=� <br />PERMIT 1t <br />� ��/-� � <br />orx� /)O,Oii �r r- i o f'�iP,!T/' <br />c� Lf L i L'� (� S v <br />PHONE <br />CONTR. LICENSE N <br />Nr'��9� �y 2.Iocii <br />�Bui�ding � Mechanical I nddition FIEAT SOURCE <br />Combination Plumbing WORK � Alteration B Electnc <br />Demoiition Sign TYPE New U Ges <br />Sprinkler Repair/Maint. U Other <br />CONTRACT PRICE OF WORK I CITV OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />WORKDESCRIPTION �IJ-Srnc� �✓,A�Ir�;a/C/'y/-"/'S lh C��1r�T�r'l /1�i�n�/vl-, <br />t/✓.� ��t' N/:�� /i ii�tU'r-i. INS i^''� �A rrF>ty Uf'N.CRrci7 S ���•ha� n�= ir"c-�o/'S <br />� ri T�r �c /_; y�?�>�'�� r' S� f_ a i; ���� _ N�i� �' !-��l�r^ S/Y � i4�r � ir �� f� �:iP I,-� �?u� � 1�1 �C l.✓�{ Srs ) <br />��'i %I.A(_ � �-l� ��`� 11Nh W' NOCi✓� l/'� ��C (,�NI r�' <br />N0. I 1YPE OF FI%TURE 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 />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FlXTURE OR ITEM <br />A/C - AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />T CLOTHES DRYER <br />1� RANGE HOOD <br />! O WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAh1E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS NPE OF WORK WIIL BE COh1PLIED WIThi WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OA LOCAL LAW REGULiTING CONSTRUCTION OR THE PERFORAtANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTRACTORS LAW 18.27 RCWi�ND 296200 WAC. <br />�.' j%'/�! � � i c• _ .?..7 <br />_- ;��� �� ���_ -�.•- � ; ! - c c <br />.� _ <br />