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7�.� <br />SITE ADDRESS <br />H <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />-�11_+E <br />TENANTNAME <br />�-ERMIT APPLICATiJN <br />CITY OF EVERETT PERMIT SERVICES ��2 <br />3200 CEDAR STREET, EVERETT, Wq 98201 <br />425-257-8810 — FAX 425-257-8857 �ZOZ - /5 -OL <br />�v cn <br />CONTRACTOR " � 0�_y� <br />!lo <br />PHONE ��+� Alb�i�[.ltt.v� <br />PROPOSED USE OF BUILDINO <br />GVN7qACT PqICE OF WORK <br />WORK DESCRIPTION <br />h � w S�y � �,.�,; <br />PLUMBING <br />NO. I TYPE OF FlXTURE OR REM <br />WATEH CLOSET (TOILETI I � <br />LAVATORY (WASH BASIN) /+1/ <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 />SI�JK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARf:�L TAX I.D. � � 0 � <br />., . _ <br />o�!.z�� <br />TAACT <br />ICONTACT NAM <br />I ��,,,�_ 11 .41�_• <br />ADDRESS <br />67►3 � hl�y►.�A.,� pr_ <br />Building Mechenical <br />PERMIT Combfnetfon Plumbing <br />TYPE Demalitfon Sign <br />Sprinkler (M of headn) <br />r� <br />19CU S�F�- <br />M <br />iuc � I c - G'< SU <br />—� ,v .� <br />LP PMONE <br />:_ �...�+ 9B� 4� -�904� <br />PHONE <br />� d v e- �a�- 3saa <br />21P CONTR, LlCENSE 1 <br />5t1.o 3 <br />�n� HEAT SOURCE <br />WORK Alteretbn E�� <br />Trne ri.w aes <br />RepsirM4lnt pp�K <br />' C1TY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />41 <br />NO. � T1�pE OF FlXTURE OR ITEM <br />A/C — A/HANDLINO UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANOE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />(3AS FIREPLACE <br />GAS RANOE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LqWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY OTHER <br />STATE OR LOCAL L4W REGULATING CONSTqUCTtON OR THE PERFORMANCE OF CONSTqUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 18.27 RCW AND 296200 WAC. <br />. .il . , . 1 .r , 1 ' I � <br />