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� <br />SITE ADORESS <br />C-',510 O <br />LEGA LOT N0. <br />�ESC. � <br />� ; <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TA% I.D. k <br />1�TCD1Z 3`129-oli-oZ-ol <br />BLOCK TRACT <br />II L�:-uERLY uru 5 li7 <br />� <br />�...._.. ..�....�.... ur rn�n�.1�..534tZ-iz5� <br />STtPHEN F1 I'Y1�LE Ar�j 6$ Ic� O�YfY1PZC. p2 q$Zo3 <br />TENANTNAME CONTACTNAME PHONE <br />_ 5Ai'Yl� AS F�uvE ST��� ,�vl��-..CaN C'�1�-3y�-�ZSi Nz�-`�sv-z�bo <br />CONTRACTOR ADDRESS 2IP CONTR. UCENSE N <br />c�w ne r <br />PHONE <br />PROP^3ED USE OF BUILDING <br />CONTHACT PRICE OF WORK <br />WORK DESCRIPTION <br />Building Mechanical Atltlition HEAT SOURCE <br />PERMIT Combinalion RL.1 Plumbing WORK Alleration R Eiectric <br />TYPE Demalilion U Sign TYPE � New u Gas <br />Sprinkler Repair/MainL LJ Other <br />2 � J= LD �2 CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />1 � Zis 3, — <br />`76 � r� �+ ��,e� (-� ,�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATEF CLOSET <br />BATHTl�B <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETCJ <br />OTHER 1JOAJC <br />NO. � TYPE OF Fl7CTURE OR �TEM <br />A/G —A/HANOLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ UNIT HEATERS <br />_ CIOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREP�CE/STOVE <br />F�REPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />� OTHER A�OhJ r <br />I HEREBV CEFITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE �AME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE �OMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOIATE OR CANCEI THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONS7RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOPIZED 8Y THE <br />OWNER OF THIS PHOPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND 1 COMPLY WITH THE STA1 E <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />�oL <br />�/z <br />