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� <br />�J <br />*ERMIT APPLICA1tJN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 , - <br />Awc.�--PrQ..n�� <br />SITE ADDRESS PARCEL TAX I.D. M I PERMIT • <br />�zoo �,�o�.� Rfl �n�i � -��l <br />LEGA LOT NO. 6LOCK TRACT <br />`TN�w+�c.aRP <br />TENANTNAME CONTACTNAME PHONE <br />�Ra�.T I �� �� <br />CONTRACTOR , ADDRESS ZIP CONTp.UCENSE� <br />TN'T �MEcNA,.s.alact, t.Lc. z2�33 ��wl-�r-► H"'1 <br />PHONE �' ��b'uj�1 Fx�-h`cl(� Wl�k 9atTL1 Tv�(Tw�cl.1Fu11F-7 <br />� <br />PROPOSED USE OF BUILqN6 <br />� Building � Mechanicel <br />CERMIT Combination Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK �� 1� 5 �o <br />WORK DESCRIPTION <br />� � -z 2 <br />S P�s-�a.�,� <br />��-P <br />NO. � TYPE OF Fl%TURE 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 ORAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHEFi <br />RAdditlon I NEA7 SOURCE <br />Alterollon �Eiectric <br />BNaw oaa <br />Repeir/Maint. Other <br />CRV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />11nl�TS I 17JcTWo�2K ��►t7 <br />�nW�r,� 'F�A�aS . <br />NO. � TYPE OF Fll(TURE OR ITEM <br />A/C — MHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />C3AS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTH[R <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAW AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANT F A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OP ANY OTHER <br />STATE OR LOCA REGUUITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THI PERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTRACTO 8.27 W AND 296.200 WAC. <br />II"702 ' <br />Signa�ure ol Owner/ConlractodAuthonzed Agent ate � <br />z <br />