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P��RMIT APPLICATI� N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />S17E ADDRESS '� �Z� �� ve PARCEL TAX I.�. N PERMI7 r <br />FvPnP'�}" �..iQ , I I (YlOLGS-0L � <br />LOT NO. I BLOCK I TRACT <br />DESC. <br />����� we � <br />TENANT N ME <br />1��' � I <br />���� c- <br />CONTRACTOR S`0\1�cV/+- SZY V �ce.L <br />PHONE �\�`�v� LD. MV`W <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIP710N <br />V <br />CONTACT NAiAE <br />�� 1 � <br />S �VIQ <br />PHONE <br />ADDRESS Y,Q, r� � h, ZIP CONTR. UCENSE N <br />��{q�� M�'ili� � 94i��S ��xs,Zv3oN <br />PERMIT j� <br />TYPE D <br />U <br />Building � Mechenical I Addition HEATSOURCE <br />Combination Plumbing WORK � Alteratlon � Electric <br />Demolition Sign TVPE New Oaa <br />Spfinklet RapeiriMeinl. � Other <br />� CITV OF EVERETT LOCAL S?�LES TAX CODE IS �105 <br />:e w��,�- �r1� � <br />�Cw SM�A'tl�'�n <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRYTRAY <br />_ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER _ <br />•he <br />�e ba o�,�r� <br />NO. �. TYpE OF flXTURE OR ITEM <br />A/C -A/HAND�ING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UN..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 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. AlL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� HERE�N OP <br />N07. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE AUTHORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCF OF CONSTRUCTION. THAT I AM AU7HORIZED BY THE <br />OVJNER OF THIS PROP RN TO PERFORM THE WORK FOP WHICH APPLICATION IS �AADE AND I COMPLY WITH THE STATE <br />COPJ,jRACTORS LAW/f�27 RCyy AND 2g6.200 WAC. <br />S —ZZ—� �. <br />