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�- <br />� <br />SITE ADDRESS <br />�a�� � <br />IEGA LOT NO. <br />r���2p <br />TENAHT NAME [�c n <br />PCRMIT APPLICATI(f.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />RD,�D <br />ELOCK <br />R�ar.�sra-rE <br />Tir� T�C. <br />CONTRACTOH <br />1?/�fE�sS�orlAt �u�MBF.25, TaJG. <br />PHONE <br />�sT- 3 43 - 4� S3 <br />PROPOSED USE OF BUILDING <br />CONTRACT PqICE OF WORK <br />PARCEL TAX I.D.1 <br />��= ;►re <br />TRACT <br />ICONTACTNAME <br />ADDRESS <br />Po QoK .�t 8' �—�: <br />C�/J�i /0�� lA�lq <br />Building Mechenical <br />aEqMiT � Combinalion �Plumbing <br />7YPE Demolition Sign <br />Sprinkler <br />JJJ +• <br />WORKDESCRIPTION ��Mg1�Cr CdMPc�f.T� <br />NO. � TYPE OF FlXTUpE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY �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 (SERV�CE/8AR/MOP/ETC.) <br />OTHER <br />1/0 -DO/ <br />PERMIT N <br />PHONE <br />ZIP CONTR. IICENSE � <br />q8oiy ��P� 19$PG <br />�dtliliai I HEA730URCE <br />A��e��� Electric <br />� Oaa <br />Hapsir/Maint. Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS �10a <br />Fvrc 7x.�,9-�r r�yP�ee�Is.M��IT <br />NO. � TYPE OF FlXTUqE OR REM <br />A/C — A/HANDLING UNITS <br />FOFCED AIR SYSTEMS <br />HEA1"PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSEFiT <br />OAS FIREPLACE <br />GAS RANOE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OFlAWS AND ORIDINAC::S GOVEtiNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOcS NOl PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL lAW REGU V+TING CONSTRI C710N OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THL' WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WlTH THE STATE <br />CONTFACTORS LAW 1E27 RCW AND 298.200 WAC. <br />Y-''d'^S, 1�.�-cn-- �=���4rrr ��%� Si-�2 <br />