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/ <br />SITE <br />�� <br />�r LoT � l�d Z-GS- 48 Qc�R,v <br />,y -� r � <br />P�RMIT O�pPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED.�R S7REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />170Cv i�i,cc..e l� <br />OESC. <br />NAME <br />PARCEL TAX I.D. 71 <br />i�3� C90Lo O/D <br />BLOCK TRAC� <br />AOORESS <br />' • ������ <br />CON7ACT <br />� �A�„ <br />CON RACTOR <br />,Qe �'iQm /z S, ��tlt� <br />PHONE�2t1,3yS- Q$'G3 <br />�J <br />PROPOSED USE OF Bl,�L01NG <br />Si�v�c,� FA•��c� <br />CONTRACT PRICE OF WORK � 7U <br />WORK OESCRIPTION <br />NO. I TYPE OF FlXTURE OR REM <br />� WATER CLOSET <br />� BATHTUB <br />� LAVATORY (WASH BASIN) <br />— SHOWER <br />�— KITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />— LAUNDRY TRAY <br />= CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />- l�S- 5'a� <br />�itl•�r.� H1,4sZyS �/1 tt.n, <br />Building Mechanical <br />PERMI7 Combinalion R Plumbing <br />TYPE -Demoiilion � Sign <br />Sprinkler <br />PHONE <br />� CONTR. LICENSE N <br />�SZZo !'ok�CHoliEa�T�� <br />Add�lion <br />WORK Alteralion <br />IYPE ew <br />Repair/Maint. <br />MEATSOUHCE <br />�Electric <br />Gas <br />Other <br />s r"CfTY OF EVEREfT LOCAL SALES TAX CODE IS 3105 <br />�i�l� 2i�s. <br />NO. � TYPE OF FlXTURE OR REM <br />— A/G—A/HANDLINGUNITS <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 />= EXHAUSTFAN <br />= OTHER <br />I HEREBY CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFiiECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HERE�N OR <br />N07. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE O�CAI LAV✓ REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER HIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br />CONT ORS LNM11B2LfQW AND 296.200 WAC. <br />��2 <br />