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� <br />� <br />SITE ADDRESS <br />LOT NO. <br />DESC.� /,. <br />PERMIT APPLICATI <br />CITY OF E'JERFIT PERMIT SERVICES <br />3200 CEDAA STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SLOCK � TRACT <br />PARCEL TAl( I.D. R <br />�� <br />�/ <br />--••--• ------- � --- <br />�/fi� co�-,o as�as' s«Md li�� .�,� 3a �m�� la,s 5a�c <br />TENANT NAME CONTACT NAME PMONE <br />� .L:.,� �G�i�'OE A'.�t�i e�s3 8'7�-7a�Z <br />CONTRACTOR ��� �cr e s <br />PHONE n _.... �- - - . - - <br />PROPOSED USE OF BUILOING <br />I PERMR <br />TYPE <br />G/pr� y.�s �.. <br />Cf1NTRACT VRICE OF WORK <br />ADDRESS aP CONTR. LICENSE I <br />7��,`�' so �os fTe�rTtc�'1 • 9t�s.2 <br />�Building <br />Combinetion <br />Demalition <br />Sprinkler <br />Mechanical <br />Plumbing <br />Sign <br />ACditbn <br />WOPK Altaretbn <br />TYPE Naw <br />RepsiqMaint. <br />HEATSOURCE <br />D Elactric <br />B 6se <br />OMar <br />CITY OF EVERETT LOCAL SALES TA% COOE IS �10b <br />WORKDEBCRIPTION �A SfA// sP�4JC/,61�� �/q p(o+� ,7'pt /IbTIi� y <br />NO• I TYPE OF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />_ IAVATORY (WASH BASIN) <br />SHOWER <br />^ KITCHEN SINK 6 DISPOSAI <br />DISHWASHER <br />LAUNDRY TRAY <br />_ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI'ER <br />_ SINK (SERVICE/BAR/�40P/ETC.) <br />_ OTHER _ <br />NO. I TYPE OF flXTURB OR ITEM <br />A/C - A/HANDLING 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 />CiAS FIREPLACE <br />OAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. ALL <br />PROVISIONS OF U1WS AND OFIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETMER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW HEGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OP TFiIS PROPERTY TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC OR AND 298.200 WAC. <br />i�iEi�.� /��/ `� � <br />