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�tRMIT APPLICATI�UN <br />CITY OF EVERETT PERh11T SERVICES <br />3200 CEDAP S7REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425•257-8857 <br />yl�'� - 033 <br />SITE ADOHESS I PAFiCEL TAX I.D. 7t � PERMiT �t <br />�n�ait-R R���. I '1� <br />LOT NO. 6LOCK TR6GT <br />unn�n <br />�Jt�tr �m� D�Sr� Z <br />TENANTNaME <br />CONTHACTOR �AF��� N t� <br />PHONE 3�p(�'jlo� ��3� <br />PROPOSEO USE OF BUILDING <br />JENI[�E MMAT <br />�73o Coc$y A�c., E��+�n <br />ICONTACTNAME <br />AL AOppE53 �t7� �ERIO(M� <br />gEU.1n1G t�1+n � u�� <br />Building (� MQchanical <br />AEFhIR R Combinatlon B Plumbing <br />TYPE D Damalilian S(gn <br />D Sprinkler <br />CONTRACTPRICEOFWOqK �y�ZOfJ <br />WORK CESCRIPTIoN <br />('�c�1ioE � IaST��� F��ac SVsr� b'r'R t'esiba <br />N0, I TY?6 GF FlXTUpE OR ITEM <br />WATEfi ClOSE7 <br />LAVATORY (WASH BASIN) C�,� Q�`� <br />K TCHEN SINK 8 DISPOSAI ��PQ� Or <br />�CG Q <br />DISHWASHEFl � � <br />I�UNDRY TRAY O � <br />� � <br />URIONAL S WASHER \,�`:�!`O ,� <br />DRINKING FOUNTAIN ���,�/ <br />FLOORORAIN A�!i ..fl' <br />BACKFIOW PREVENTER � <br />SINK (SEfiVICEl6AR/MOP7ETC.) <br />OTHER <br />96�c3 <br />ZIP <br />J82� <br />36E-'173� <br />CONTR. UCENSE N <br />gAeR ONA 179 D 7 <br />Addition <br />Alleration <br />New <br />Rcpa(�'MainL <br />HEATSOURGE <br />�Eleclrie <br />Gas <br />Olhor <br />CfTY OF EVEARTT LOCAL SALES TAX COOE IS 3105 <br />NO. I TYGE OF FlXTURE OR ITEM <br />AIC —A/HANDUNG UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLAGE/STOVE <br />FIREPL4CE INSERT <br />6AS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />�qo <br />I HEFE9V CERITIFY 1'HAi I FIAVE REaD ANo EXAMINED THIS aPPLICATION AND KNOW TME SAR1E TO BE TRUE AND COIiRECT, AlL <br />PROVISIONS O� U+WS ANO ORIDINACES GOVEqNING THIS TYPE OF WORK WILL BE COMP�IED WITH WHEfHER SPECIFIED MEREIN OF <br />NOT. THE GRANTING OF A PEPM�T DOES NOT PRESUME TO QIVE AUTHOtiITY TO VIOLATE OR CANCEI THE PROVISION OF ANV OTHEN <br />STaTE OR LOCaI LAYJ AEGULATIN6 CONSTRUCTION OR THE PERFORMANCE OF :ONSTRUCTION. TMAT I AM AUTHORIZED 6Y THE <br />OW�vER OF TMIS PROPERTY TO PERFOAM THE WORK FOR WHICH APPUCATION IS MADE AN01 COMPIY VviTH THE STATE <br />CONTRAC70R$ LAW 1827 FiCW AND 296.200 WAC, <br />Signalure of wnerr ontraclor/Au�horized Aganl eto <br />