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� ` ' - 1�ERMIT APPLICATI�N <br />�,w���,,. CI7Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, E}(ERETT, WA 98201, 425•257-8810 <br />SITE AODRESS <br />3�i5 c�.��..a.y� <br />oesc. � (5� �+��.� <br />OWNEA <br />�Tr' Su�av� oiYr¢�c�' <br />TENANTNAME <br />CONTRACTOR �` ; ��� � <br />PHONE <br />PROPOSED USE OF BUILDINO <br />�� �O� <br />� �1� <br />CONTRACT PRICE OF WORK <br />PARCEL TAX IA, M I�Z(� - <br />�e�5-3-�1 "d�- <br />CONTACTNAME <br />ca.�c Ku.Ai�G*���a�l <br />ADORESS <br />Building DMe�l anicat <br />PERMIT � CombinaCwn �1 Plumbing WORK <br />TVPE Oemolition U Siyn TYPE <br />Sprinkler <br />� <br />PHONE <br />4ZS-�ePy- 4� 30 <br />CHONE <br />u� -(�A-T�s <br />� CONTR. LICENSE • <br />( <br />�Atltlilivn HEAT SOUqCE <br />Alterntbn � Electrlc <br />Nuw Ga: <br />RepsiUMafnt. O�her <br />CITY OF EVERETT LOCAL SALES TAX COOE IS �105 <br />WORKDESCRIPTION QECO�OFy4� �SKtI�- Y�'iW4tLS� �UC�T��7 ��-�-- <br />��.��F1�0 r <br />� <br />TYPE OF FlXTURE OH IT�M <br />WA7ER CLOSET <br />6ATHTUB <br />LAVATORV(WASH �ASIN) <br />SIIOWER <br />KITCHL'N SIKX 8 DISPOSAL <br />DISHWASHER <br />LI�UNI7RY TRAV <br />CLOTHCS WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />F100R DRAIN <br />BACKFLOW PREVENTER <br />SINK (SEf1VICE/BAR/MOP/ETC,) <br />OTHER <br />NO. � TYPE OF FlXTURE OR REM <br />A/C — MiANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVER <br />RANOE HOOD <br />WATER HEATER <br />METAL FIFiEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPUICE <br />GAS HANOE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER ^ <br />I H[R[BY CEf11TIFY TNAT I NA�E READ AND EXAMINED 7HIS APPLICATION A�D KNOW THE SAME TO BE TNUE AND CORRECT. ALL <br />FROVISION501� LAWS ANOOf11DINACES GOVERNING THIS TYPE OF WOHK WILL BE COMpIIE� WITM WHETHER SPECIFiED HEREiN OR <br />NOT. TNE GfiP4TING OF A PFRMIT DOES NOT PHESUME TO GIVE AUTHORITY TO VIOLATE OR CANCELTHE PROViSION OF ANV OTHER <br />STATG Ofi LQCAL UW �EGUUTING CONS7RUCTION Oli THE PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHORIZED BV TNE <br />OWNER OF TI!IF pf1UPC•H fY TO PERFORM TNE WORK FOR WHICH RPPLICATION IS MADE AND I COMPLY WI1H THE STATE <br />CONTRAC�005 UW 18.2� RCW AND 296200 WAC. <br />'-- 3��,1,�02 <br />`L <br />