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P�R�VIIT APPLICATIEN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS N� I l � n 1� I�2 fl�� <br />F, ,-� <br />LEGA LOT NO. <br />DESC. (p <br />PARCEL TAX I.D. N PERMIT M <br />�t3�gc�o�oo(�oo � t�r„ <br />�LOCK TRACT <br />OS- �VP2�+'r D1�1 � <br />Q�,�l. k l�.qTH4lw1 L��o�l <br />TENANTNAME <br />fi�( O,n� <br />CONTqACTOR <br />�'QGtt=�L. <br />PHONE y Z� Z?9 <br />PROPOSED USE OF BUILDING <br />9 �- i A �r�,z,� <br />�T A R 1� C.,'�. <br />GONTqAGT PpICE OF WORK <br />WORK DESCRIPTION <br />2711 RAi��,=2 A�� 943Z1�� 'izS <br />1.S'i Z`i 1'7 <br />CONTACTNAME PHONE <br />I 7A��r� q�pQi,�t:.� 4Z� Z�S 13►� <br />��rA�es ADDRESS Z�� ���ke?- A�� �p r,ONTR.UCENSEN <br />�3i1 �J��- c�zL� PAc��trio88�-�1 <br />ewiaing Mechanical <br />PERMIT Com6ination Plumbing <br />7YPE Demolition Sign <br />Sprinkler <br />Addilion I NEAT SOURCE <br />WORK Alteration ❑ Electric <br />TYPE New ;� Ges <br />RepaidMeinl. U Other <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />/�",� z43 = y� t�( D� ����.� G-� cz�.cr� <br />NO. � TYPE OF Fl%TURE OR ITEM <br />_ WA I tH GLOSET <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK & DISPOSA� <br />_ DISHWASHER <br />_ LAUNORY?R�Y <br />_ CLOTH[S WASHER <br />_ URINA� <br />_ DFINKING FOUNTAIN <br />_ FLOOR ORAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOPlETC.) <br />_ OTHER <br />NO• I TVPE OF FlXTUpE OR ITEM <br />iv�. - wriANULING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <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 />I NEREBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4W5 AND ORIDINACES GOVERNING THIS TYPE OF WORIC WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOUITE OR CANCEL THE PHOVISION OF ANY OTNEfl <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />_ � .,-� 1� .SZ _ Q _ <br />`^ S-3�..-,� <br />