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SITE ADDRESS <br />P�RMIT APPLICATIC��J <br />CITY OF EVERETT PERMIT SEHVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />LEGA� LOT NO. I BLOCK <br />DESC. ' <br />(n! i��ncG' � <br />PARCEL TAX I.D. k <br />TRAC7 <br />SEAJ1Ev.i i�iQ..141y:} <br />Ip_ <br />(.Ul�.t Ii1M F t JV1E+�R�1 L SrCRI/wJlr ��0� �O Nl�a_SIO� �.N 'ly'��j Y•�-l�'3�b':�id�y <br />TENANT NAME � CONTACT NAME PHONE <br />l`E A� I ���. S'r'E,�",.�cr '-/Z.i -743-S�dJ <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE M <br />St�r �.blt, �-1�ks�otLH. ����«r.,u.7�.. 9A'i�3 <br />PMONE <br />`i1.i - 3s l� -Z`r �' �l <br />PROPOSED USE OF BUILDING <br />��510 <br />CONTRACT PHICE Of WORK �� �� J J <br />Building Mechanicat <br />PERMIT �Combinatian R Plumbing <br />TYPE Demolition � Sign <br />Sprinkler <br />Addition HEAT SOURCE <br />Alteralion �Electric <br />New Gas <br />fiepair/Meint Other <br />CITY OF EVERETT LOCAL SALES TA% COCE IS 3105 <br />WORK DESCRIPTION <br />�;Es�oeNrih.. Qpo�.-��i�; CrA�h�.�� 9d�� S,�F,- <br />' f3toa.oun�.�34rK,Ext,�ei�� GJ'Ssa.=: <br />NO. � TYPE OF FlXTUHE OR REM <br />WATERCLOSET /� <br />BATHTUB / <br />LAVATORY (WASH BASIN) ' <br />SHOWER � <br />KITGHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY � <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEF; <br />SINK (SERVICE/8AR/MOP/ETC.) <br />GL'.2 <br />TYPE OF F�XTURE�OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP � <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGENOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSEFT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST fAN � <br />OTHER <br />� U ' <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF U1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfFiER SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF A�lY OTHER <br />STATE OR LOCAI L4W FiEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 �AND 296.2001VAC. <br />7-11-0 <br />