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P�RMIT A�'PLICATI�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 <br />l7OL WU(o�'r' D�Q <br />LEGA LOT N0. BLOCK <br />DESC. <br />OWNER <br />%�L Ii�A/YJC.rS <br />TENANTNAME <br />CONTRACTOR <br />/ZOg�NSJN Pu•-•,.ran�, �r-c. <br />PHONE <br />PROPOSED USE OF BUILDING I <br />S� <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK � � � <br />IPARCEL TAX I.D. N <br />TRACT <br />AODRESS <br />CONTACTNAME <br />ADDRESS <br />�923U i�-fl�dv�' ^-L-r <br />�-.2C--l.✓(i!'77�./ (.�-9 <br />Building n Mechanical <br />Combination � S Plumbing <br />emolilion D Sign <br />Sprinkler <br />t <br />PHONE <br />7JP CONTR. UCENS� N <br />4f�LL3 �B/"'P'i�2,7LCL, <br />Addilion HEAT SOURCE <br />K Alteralion � Electric <br />ew Gas <br />RepairlMaint. Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />/ NS Tr4"L�- �L/I�E S/�.Q•t N,l CCYLS /•�..J .VG�ti S F,e <br />N0. � TYPE OF FI%TURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN S�NK & OISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />� <br />NO. � TYPE OF FIXTURE OR REM <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 />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />.</�i2.�w�KLC'72 f%CNOt <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTRACTORS LAW 1�.2yaCW A97D�296.200 WAC. <br />y <br />