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SITE AODRESS <br />LOT <br />TENANTNAME <br />f =RMIT APPLICATK-)N <br />CITY OF EVERETT PE4MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK I TRACT <br />corm+acro <br />d Nt �ty��F �.1� (� <br />PHONE <br />�liv- i'l�/'_ �_ll�_LF <br />PROPOSEO USE OF BUILqNG <br />S 1Nt, <br />CONTRACT PRICE OF WORN <br />WORK DESCRIPTION <br />PARCEL TAX I.D. • <br />ADDRESS <br />S�UD 3 1ib ST S1..1 <br />LYn.+N wW� <br />Building Mechenical <br />PERMIT B Combinatlon � Plumbing <br />TYPE D Demolition Sign <br />�� Sprinkler <br />((k-�r�P� s- wIS <br />NO. I TYPE OF FlXTURE OR REM <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 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 />� � .� .� .� <br />.. <br />N <br />�4as� f?'ln- <br />aP CONTR. UCENSE • <br />�y r� �,.iN,�ao�yc,� <br />I7 AddiNon <br />F� Allerelbn <br />�..1 New <br />LJ RspeirRAsint. <br />HEATSOURCE <br />�ElacYric <br />Oas <br />OIhH <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />NO. I T�'PE OF Fl%TURE OR ITEM <br />A/C - A/HANDLING UNI7S <br />FORCED AIF SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />DAS FIREPLACE <br />GAS RAN(3E <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I NEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A FERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHER <br />STATE O Al LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER F IS PROPj� TY1�jO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTR S L.qW �.2f y��tN AND 298.2�0 WAC. <br />'�f-6 <br />