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SITE <br />PiRMIT APPLICATI�,V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />51+� 6J�re�" 9 g2o3 <br />BLOCK <br />TENANTNAME <br />� I <br />a�Cctit%. ez�a <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILOING <br />CONTRACT PqICE OF WOpK <br />WORK DESCRIPTION <br />ADDRESS <br />PARCEL TA% I.D. N <br />Tt�l„Q. QO��'t�L` <br />� �. <br />Building � Mechanical <br />PERMIT Com6ination Plum6ing <br />TYPE Demolition Sign <br />Sprinkler <br />Rr.�b�e� 0 � l �►. <br />(�e� ��ti <br />NO. I TYpE OF FlXTUpE OR REM <br />I I — <br />I ' - <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />1..1UNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Z <br />�ve <br />ZIP <br />Rg�3 <br />yZ, <br />ZIP <br />PERMIT M <br />IqGL� <br />�t5 347 6313 <br />PMONE <br />3�Fi- �3(3 <br />CONTR. LICENSE M <br />Addition I HEAT SOURCE <br />WOPK Alteration ,Q Electric <br />TYPE New {9.Gas <br />Repair/Maint. U Other <br />I CfTY OF EVERETT I,OCAL 3ALES 7AX COOE IS 3105 <br />1�„ �� �+�� � �, t�.�- <br />NO. � TYPE OF flMURE OR ITtM <br />A/C — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAI FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER_�_ <br />I HEF'EBY CERITIFY 7HAT I HAVE READ AND EXAIAINED TNIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CURRECT. ALL <br />PROV'SIONS OF uWS AND ORIDINnCES GOVERNING THIS TYPE OF WORK WILL BE COMPLlED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. � HE GRANTING OF q PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEH <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THqT I AM AUTHORIZED 8Y THE <br />OWNER ��F THIS PROPERTY TO PEFFORM THE'NORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�� �,— T 1b-9-02. <br />