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P�RMIT APPLICATIC.� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, NIA 48201 <br />425-257-8810 — F:,.� 425-257-@857 <br />21�10 <br />SITE ADDRESS <br />LOT NO. <br />`i-�s <br />1t:Qt Lc� <br />FLOCK <br />L <br />mH�0.b r� t1 �nJ -$ �. ��' b <br />IKq (if41-_3arJiv_ <br />PARCEL TAX I.D. N <br />GGS 7 GY�� <br />THACT ,� <br />Se'VV•WJ �fl�.�T <br />ZIo�O i-�,I�S.`,QQ C.a.'e <br />TENANTNAME CONTACTNA <br />s�'n.�, �� . �i�t%CL <br />CONTRACTOH � JS e � ` � ADDRESS <br />T p� ��l tl 2� <br />PHONE <br />yZS•S�4_ <br />PROPOSED USE OF BUILDING <br />s+�Y.y�,.9. �t�. �j. <br />(� 6uilding (((��� Mechanical <br />PeRM1T D Combinalion I�} Plumbing <br />TVPE Demotilion D 8'gn <br />B Sprinkier <br />CONTRACT PRICE OF WORK �p ��c�:t <br />WORK DESCRIPTION K�� 1����� .` ntA •f l�` <br />WrY �� t <br />NO. I TVPE OF f�XTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />_ LAVATORY (WASH BASIN) <br />SHOWER <br />1 KITCHEN SINK 8 DiSPOSAL <br />� DISHWAS4ER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UAINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW P��EVENTER <br />_� ;iINK (SEFVICE/BARlMOPlETC.) <br />PERMIT IJ, <br />3 <br />E G _ <br />3v�•6Gqb <br />�r_ I. PFIONE ��p <br />'i�1.K� � Z.� — al T � % %(�Q <br />LP CONTR. 4CENSE N <br />5eZ1 Z l-fo�sa N-?I- �bz►+� > <br />Atldition <br />Alteration <br />Now <br />RepeiNMaint. <br />HEATSOURCE <br />Electr _ <br />Gas <br />O[het <br />CRV OF EVERETT LOCAL SALES TA)( CODE IS J105 <br />N0. � TYPE OF FIICTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />PANGe HOOD <br />WATER HE4TER <br />METAL FIREPLACE/STO�'E <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEPEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WWS AND ORIDINACES GOVERNING TFiIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEAEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PFOVIS�ON OF �NY OTHER <br />STATE OR IOCAI LAW REGUTATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTNORIZEO BY THE <br />OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH APPL�CATION I5 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORSLAW�7�C�G200WAC. <br />� / ���' � � �� <br />Signa r nenConlractor/Authorized Agent Date <br />r ��.� I <br />