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SRE ADDRESS <br />y Z'] n <br />LEGA LOT NO. <br />TENANT <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />aN 2d <br />BLOCK <br />col+r�aceo F�0.me G�s StNic-� <br />H <br />PHONE <br />�{25 -y83-3�'1 <br />PROPOSED USE OF BUILDING <br />�LS�t�'tnct <br />PARCEL TA7( I.D. � <br />TRACT <br />y 2"] m <br />� CONTACT <br />PERMIT N <br />fMl D I11-Oa19 <br />aP PHONE <br />q8�Zo3 yZ5-5/3-�i� <br />PHONE <br />ADDRESS 21P CONTR. LICENSE M <br />IifSyo leo"�4ut Kenrv�or� I�a 98U2fr (��EfG5ofo0QfY1 <br />Building Mechanical <br />PERMI7 R Combinetion � Plumbing <br />TYPE g Demolition U Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK 1f I��,� <br />,� <br />�Addition <br />Alleration <br />New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETf LOCAL SALES TAX COOE IS 3705 <br />WORK DESCRIPTION <br />G�s Fu�n�ce c.,1�10.v�o�t oui' mode� � RG PH U��A�lEK <br />NO. I TYPE OF flXTURE OR ITEM <br />WATER CLOSET <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/BAR/MOP/ETC.) <br />OTHER <br />NO. � TYPE OF Fl%TURE OR fTEM <br />A/C — A/HANDLINO 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 />OAS FIREPIACE <br />GAS RANf3E <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES C30VERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STAT� <br />CONTRACTORS LAW 1827 RCW AND 2982tl0 WAC. <br />