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SITE ADDRESS <br />�71b P� C <br />LEGA LOT NO. <br />E �. �i t�-.f <br />TENANT NAME� <br />�/� <br />F�.:RMIT APPLICATI�N <br />CITY OF EVERETf PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />i �oy <br />���.r <br />PARCEL TAX I.D. A <br />TRACT <br />�(/� 5���� <br />CONTACTNAME <br />�c �� <br />PERMIT N <br />'L <br />� �VL�,(� <br />CONTflACTOR � r� /� y� � ��/ ��C <br />JP (, �� <br />/ �C�Q� ���i/V,k: <br />PHONE 2, � �/ U '7 Jl �i % 4 �YTZL `� � LL.�` � L!//T �� <br />PROPOSED USE OF BUILDING <br />�S i �t 1✓ l'� rt'C� <br />CONTRACT PRICE OF WORK <br />PERMIT <br />TYPE <br />WOflK DESCRIPTION �P �+ �� vr� <br />NO. I TYPE OF FlJ(TURE OR REM <br />I y WATER CLOSET <br />I:�BATHTUB <br />LAVATOFY (WASH BASIN) <br />SHOWER <br />= KITCHEN SINK 8 DISPOSAL <br />I DISHWASHER <br />LAUNDRY %RA�Y <br />CLOTHES WASHER <br />� _ URINAL <br />DRINKING FOUNTAIN <br />I _ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERV�CEiBAR/MOP/ETC.) <br />Building � Mechanical <br />Cambinalion Plumbing <br />Demolilion Sign <br />Sprinkler <br />20(, <br />' � �� <br />ZIP CONTR. LICENSE N <br />U ��� � L"�,`a77wt�4 <br />�Addilion <br />Alleralion <br />New <br />Repair/Mainl. <br />HEATSOURCE <br />Electric <br />Gas <br />o�ha� p, <br />CfTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />N0. I TYPE OF flXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEFS <br />CIOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHE � <br />I HEREBY CERITIFY 7HAT i HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN Oi; <br />NOT. THE GRANTING OF A PEfiMIT DOES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCcL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CODISTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORh1 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />0 OZ <br />5C—. O? �5 �/o-Z <br />