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PE_ �MIT APPLICATIO.�. <br />CITY OF EVERETT PERMIT SERVICES <br />T 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS /,� � <br />' O / 7 h��' <br />LEGA LOT NO. <br />OESG. ^7 <br />`� J��-��� <br />TENANT <br />j�� -,-,- r <br />BLOCK I TRACT <br />-eSSo/' �'%?"o; <br />PARCEL TAX I.D. fF <br />� Z <br />Y Sl(l�/y -S¢� 23�% 2�1 <br />�°x22 y� q8x/3 <br />:�i ,�r�a <br />CONTACTNAME <br />�A�zv S�-essm <br />CONTRA �RSSC�/7��i'(�'a.L q""`„A(���� <br />PHONE rJ <br />L , t-/� � �Q �' jl�I�.�/ <br />PROP SED USE OF BUILDING � uilding <br />PER�11T Com6inalion <br />�� A TYPE Demolition <br />' 1i1L � Sprinkler <br />, -.. ,�e <br />2 Y9 <br />� �.a..�.�o y <br />p�� ��; , <br />�J <br />��RMIT MI / � <br />' �3-oaS <br />f'� <br />7NE <br />y�s 3 y�s9�'O <br />PHONE � <br />y�� 3 y3 =� <br />�IP CONTR. LICENSE M <br />9�.�i3 J�_Ssn�'/os�� <br />. <br />t�Aechanical Addilion HEAT SOURCF <br />�?lum6ing WORK Aiieration EI ctric <br />Sign TYPE ':=w Gas <br />Repairitdaini. Olher <br />PRICE OF WOflK /�� ���� �/ � J`'��') I CITY OF EVERETT LOCAL SALES TAk CODE IS 3105 <br />WORK DESCRIPTION � <br />C,���u� .✓�� S�',� ��z�,c <br />NO. I TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET <br />� BATHTUB <br />I � LAVATOHY (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 (SEFVICE/BAWti10P;ETC.) <br />OTHER <br />,� <br />J �_'''',-- '''' �-Z <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEPE9V CEFITIFY'HAT I HAVE READ AND E.<AP.IINED THIS APPLICATION ANO KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PFOVISIGNS OF LaWS AND ORIDINACES GOVERNING THIS NP` OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIP�G OF A PEP6f�T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOl�1TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUWTING CONSTRUGTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTIiOPIZED BY THE <br />O�VNE(i OF i HIS R�OPERIY TO PERFORM THE'NORK POR WHICH APPLICATION IS M11ADE AND I COM1IPLY WITH THE STATE <br />cl]NTRACTORS IU V 1827 FC'N AND 296.240 WAC. <br />r�r . °� ry �: <br />i ' � <br />r <br />