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SITE ADDRESS <br />LOT NO. <br />DESC. <br />P�RMIT APPLICATIL�� �,��sj��= <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />IPARCEL TAX I.D. A <br />m� �, � ��y»aa o�_� <br />TRACT ' <br />ICE dl /L GJeR7-N l�rl�5 <br />M <br />30-� �L I <br />uwnen �tlNp L�t�ys� AUUMt�� ur ��.,n� <br />sEt/ t3�. rs�T .�szr octR�1 �}�� . � <br />TENANTNAME � CONTACTNAME PHONE <br />COhTRACTOR <br />PHONE �� �� <br />PROPOSED USE OF BUILDING <br />WIaT'M!R r� �h�.J <br />AP11 �a�t-w.4. w�'� <br />CONTRACT PAICE OF WORK <br />WORK DESCRIPTION <br />5'z� 3�/� -y o o % <br />AD�RESS <br />Building Mechanical <br />PERMIT �Combination � Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />/`�' ��� � <br />l�� <br />�l�l� , � � <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />��_� SHOWER <br />�_ KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />C�OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />� SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />LP CONTR. LICENSE M <br />�AdCition HEAT UURCE <br />Aileration Electric <br />New Ges <br />Repeir/MaiM. Q„ ,�,Oth9k- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3/05 <br />NO. � TYPE OF FlXTURE OR REM <br />A/C — A/HANDLING 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 PIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />1 HEREBY CERITIFY ?HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br />NOT. THE GRAP�TING OF A PERAIIT �OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEH <br />STATE OR IOCAL LAW qEGUlA71NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O�VNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPUCATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTFACTORS LAW 1827 FCW AND 296.200 WAC <br />� ., /J n � � _ „ 1�.� l., � <br />'(z <br />