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� <br />�� <br />SITE <br />LOT NO. <br />OESC <br />�ERMIT APPLICA��ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />��,�� ��l <br />� <br />BLOCK <br />TRACT <br />PARCEL TAX I.D.11 <br />zc <br />�dLa�2 E��4-�tz-Qa�se� �i-C, ilo3a 3s�Au�S� ��Fhetl 98o�a, 4as-��sti-n� <br />TENANTNAME I COKTACTNAME PHONE <br />�-�t�-e�sl� `ia5-'1�k3 -1'I l8 <br />CONTRACTOR � ADDRESS aP CONTR.UCENSEI <br />Ae�0.�i���p��,���..e� �-1c�3�.-=�s�`'Aues�. t?�o�i1�.11 qgo��. ADAItc�4e <br />PHONE <br />PROPOSED USE OF BUILDING <br />R�S (c�.P.A-:a4. <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTON <br />wlding echenical <br />PERMi7 Combfnalfon lumbing <br />TYPE DemolfUon Sign <br />Sprinkler <br />j� Addn�on <br />C� � tlon <br />D�Repnir/Malnl. <br />HEATSOURCE <br />D Electric <br />u�� <br />CRY OF EVERETT LOCAL SALES TAX CODE IS 910b <br />S�+-C� �-ua-A_ \ U 4" ..h3_uJ Jl.t.o..�cQa.���c- ��L1 C. o'I � Cc' !� <br />NO. I TYPE OF flXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK.B DISPOSAL <br />DISHWASHER � <br />LAUNDRYTRAY <br />CLOTHES WASH�R <br />URINAL <br />DRINKING FOUtJTA1N <br />FLOOR ORAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHEH <br />NO. I TYPE OF Fl%TURE OR ITEM <br />A/C - AMANDLING UNITS <br />FORCEO AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOV E <br />FIREPLACE INSERT <br />GAS FIflEPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <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 LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. TI1E GRANTIN� OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWN°'^ OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONI, ��CTORS LAW 1027 RCW AND 298200 WAC. <br />