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' R"'=RMIT APPLICATI'`,N <br />���!� CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS STE PAR EL TAX I.D1 q <br />��� �At �'-� � 10�- Z��v7_OCxtalZa� <br />LOT NO. � 9LOCK � TRACT <br />� <br />cJ�O <br />11-00 <br />� Huunooa �, � ur rnvivc <br />�LS 1 � �O � Lct�51 �r�EzuvE ��I(� Zc�,�S�2- �ToS <br />TENANT NAME UNTACT NA�9E PHONE <br />aar-�'�� -- --- I�� I E�v�,l�r �is-d6�-�S� x Z� <br />C' I+�A� E�D <br />PHOI{E�� ��3 <br />« <br />�r�E fi�i-�or��n� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK <br />ADOpESS �/ I� <br />��%� I`I� � /TVG Il%E <br />�c1mDn✓�r c.� � <br />�Building <br />ombination <br />emolition <br />Sprinkler <br />RMechanical <br />Plum6ing <br />D Sign <br />ZIP <br />��z <br />CONjR. LIc�ENS� <br />�ri riP.i�r <br />�ddition <br />Alteralion <br />New <br />Repaiqldaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />WO DESCRIPTION f� � / <br />�ECcx+�-T� z� IWD `I �i.��.u75 �� EX(S�� b�cE <br />� Z7 �c�iD4✓'� ►N rvcr,J oF�rcE /t�L��nviJ <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />I.AVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNOAYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />N0. I NPE OF FIXTURE 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 FIFEPLACE/STOVE <br />FIREPLACEINSERT � I <br />GAS FII3EPLACE <br />GAS RANGE �� <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />0 <br />1 HEflEBV CERITIFY THAT I HAVE READ ANO EXA�dINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PflOVISIONS OF L1WS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COhiPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUA1E TO GIVE AUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTflUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNE O S PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS h1ADE ANO I COMPLY WITH THE STATE <br />CONTRA T S LAW,1H.�3-qCW AN� 296200 W C. <br />u' IYv I �� � �! �CJ 'OC> <br />�/� <br />