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� <br />SITE ADDRES5 <br />P� �MIT APPLICATIO� _ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />DESC. I I <br />OWNER � �_ _ I <br />� KA%i ti..i.i� <br />TtNANT NAME <br />� <br />�coH��lQ� �'1(C.. l <br />PHONE ?�O /(—( � 7� �� <br />J 0 "l l) <br />PROPOSED USE OF BUILDING <br />� n S�'�e.(/�Q-f�l � <br />CONTRACT PRICE OF WORK <br />Wo�� �!f Q?N� i�- <br />�.vr t/ �" � <br />BLOCK <br />PARCEL TAX I.D. N <br />ADDRESS <br />�� 1�1� <br />CONTACTNAMF <br />Vl `� � \I �r �r�n a c�,uu. <br />,�(��,,n I�DDRESS I �� <br />-Tica� � ��;: <br />� L <br />� I f <br />Building echanical <br />PERMIT � Combination rlum6ing <br />TYPE Demolition Sign <br />Sprinkler <br />� 3 �'� 5 ��'� <br />N0. I TYPE OF FIXTURE OR ITEM <br />S�(S�y� <br />_ WATER CLOSET �� �\ <br />BATHTUB <br />_ LAVATORY (WASH BASIN) �Q Q�Q <br />SHOWER <br />_ KITCHEN SINK & DISPOSAL �J � <br />DISHWASHER <br />LS�UNDRYTRAY l,� �� G� <br />_ CLOTHES WASHER �� � Cj _ <br />-- URINAL ������,,1;.1 <br />ORINKING FOUNTAIN <br />FLOORDRAIN J� '�' <br />BACKFLO�V PREVENTER � 1� � <br />SINK (SERVIC63AR/MOP/ETC.) Q � 1 <br />OTHER ` <br />PERM1�',�t� <br />�- <br />/n�,� <br />PHO�rNE � <br />�'^" G'72 I <br />PHONE <br />�,2-yyo / <br />CONTR. LICENSE M <br />' �P�3Zm� <br />R�a�73 , � <br />Addition HEAT SOURCE <br />WORK Iteralion D Electric <br />TYPE New D Gas <br />Repair/Maint. U Other <br />CITY OF EVERETT IOCAL SALES TAl( CODE IS 3105 <br />rc <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C —AlHANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />_ UNIT HEATERS <br />CLOTHES DRYER <br />� RANGEHOOD <br />_ WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />_ GAS PIPING <br />_ EXHAUST FAN <br />_ OTHER _ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SA61E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OP IAWS AND ORIDINACES GOVERNING THIS TYPE OF WO(iK WILL BE COMPLIED WITH WHETHER SPECIPIED HEREIN OR <br />NOT. THE GRANTING OF A PER1dIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PflOVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERPORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OlV^lER OF THIS PROPERTY TO PERFORh1 THE WORK FOR WHII;H APPLICATION IS h1ADE AND I COM1IPLY WITH THE STATE <br />CO�lTi3ACTORS LAW 18.27 P. �W AN� 296.200 WAC. <br />