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SITE ADDRESS <br />DESC <br />P�I�MIT APPLICATIGN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />;� % PARCEL TAX I.D. # <br />�c.ER� A�lC 392qoy-y-oz2- <br />W` �Kc'_ fz��ci� <br />TENANT NAME <br />��N <- <br />CONTRACTOR <br />�a G < <-.� �7'n rGeJtn <br />PHONE yZ�, L�9 �'S�1 <br />o�—lq—�z <br />PERMIT # <br />7, r0_ <br />SHo2c AcSZ�z-�n F7n�iiar.l <br />ADDRESS iPHONE <br />5��9 �c�•4�� Av�E <br />CONTACTNAME <br />-p A v� o A ��¢'� n l,-.E <br />ADDRESS <br />Z,�ZO R•�e.ltci.}��x <br />4z,- 3ss ztiti <br />PHONE <br />yZS z5S l3ri <br />CONTR. LICENSE k <br />�Ac�: !c� o93�h1 <br />PROPOSED USE OF BUILDING � Building � Mechanical nddition HEAT SOURCE <br />PERMIT Combinalion Plumbing WORK B niteration � <br />'.� <br />TYPE Demolition Sign TYPE D New Gas <br />f_.�(�,�,d�_� r� Sprinkler Repair/Maint. 01her <br />CONTRACT PRICE OF WORK L� � `'; �'�� ' CITY OF EVERETT LOCAL SALES TAX CUO S 3105�— <br />WORKDESCRIPTION ����� *�e,,,,� j>c�,�,n.nr� 7a-St����-�- �+'�a�'�ncHrJ o-ARafi� <br />NO. I TYPE OF FIXTURE OR ITEM <br />I ✓ WATER CLOSET <br />� ✓ BATHTUB <br />� ✓ tAVATORY (WASH BASIN) <br />�� KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.; <br />OTHER <br />N0. I n'PE OF FIXTURE OR REM <br />� <br />� <br />� � <br />�G <br />t / <br />A/C – A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAI.IINED THIS APPUCATIOP! AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COh1PLIED WITH lM1'HETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING C'F A PERh11T DOES NOT PRESUME TO GIVE AUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LA6V REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT � AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERTY TO PERFORht THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTPACTORS LAVY 1827 RC1N AND 29E200 WAC. <br />...� /���-� �� 9�y��� <br />r ol Owner/CoNractodAuthonzed Agent Date � <br />/a. <br />