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SITE ADDRESS <br />.�S/ 7 �n� r7M� ��� <br />LEGA LOT N0. <br />DESC. 9/.-�-,_ _ , �v <br />PERMIT APPLICATION <br />C17Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 �'"� G��� <br />v. G v=:': <br />BLOCK <br />3 �' <br />PARCEL TAX I.D, k <br />5�.�� � �� � <br />TRACT <br />�/ N[-Hv RS T <br />6vo <br />� I J IS/O rI i� <br />PERMIT � <br />�os�PN U 4,.�s l�,a�zdav�r /-i ()�c��., �s`l7 i�7nu�.�-fj-v 9t2�; s/3-�ziy <br />TENANTNAME CONTACTNAME PHONE <br />CONTRACTOR <br />�`� .J �J c i� � <br />PHONE <br />ADDRESS <br />ZIP CONTR. LICENSE M <br />PROPOSED USE OF BUILDING Buildi��g Mechanical Atldilion HEATSOURCE <br />PERMIT'-- Combination R�( Plumbing WORK Altera�ion Electric <br />C ��-� 4/� TYPE i�Demolilion �j Sign TYPE Naw � Gas <br />J (� U Sprinkler (x of heads) Repaii/Meine L� Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />WORK DESCRIPTION <br />A�� ���f'�'or. �2�' SC�2�FT. aF Gil/i N� �o���r �;�- �i,v,Nc kc�,�� .;p��c <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING fOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARlMOPlETC.) <br />OTHER <br />i ' -' <br />NO. I n'PE OF FI%TURE OR ITEM <br />f <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 />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER _ <br />I HEREBY CERITIFY THAT I HAVE READ AND EY.AM11 W[D THIS APPLICATION AND KN01V THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LA\NS AND ORIDINAC[S GOVERNING THIS TYPE OF WORK 1NI�L BE C01�9PLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERt�71T DOES NOT PRGSUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORA7ANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF Tf115 PROPERN TO PERFORM THE WORK FOR WHICIi APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AIJD 296200 bVi ,C. <br />Signature of OwnedComraclodAuthonzed Agent Date � I� <br />