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SITE ADDRESS <br />IEGA /yL0 N0. <br />DESC. <br />� <br />TENANT NAh7E <br />PE. �MIT APPLICATIO'. � <br />C:ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98207 <br />425-257-8810 - FAX 425-257-8857 <br />� PARCEL TAX I.D. # <br />� SfJ7o 00 � <br />BLOCK TRACT <br />ADDRE 5 <br />��o�� Q� dox �y <br />CONTACTNAME <br />G�N+- -�ti11 <br />� ,. a-�--�3 <br />;:���= �___ <br />PERMIT # n <br />G a��' �i.�l <br />�-fy-0/ <br />PHONE <br />°/�,2%J 87(o'/IO' <br />PHONE <br />5�as- s7� -ur� 4 <br />CONTRACTOR A�DqESS ZIP CONTfl.UCENSEN <br />7r.�d� o-� F Co, p� 'rF�H p CiF 09aN7 <br />PHONE PO� ��X %� +11uK:I�[O 'oO�7r <br />5'�S- 4'3�'-�i�8'3 <br />PROPOSED USE OF BUILL,�.G �iBuilding � Q Mechanicai Addition HEAT SOURCE <br />I PERMIT E_� Combination I) Plumbing WORK �Alteration (�� lectric <br />TYPE �( Demolilion ❑ Sign TYPE New �Gas <br />lJ Sprinkler RepaiNMaint. Otner <br />CONTRACT PRICE OF WORK /(r ,� � J � <br />WORK DESCRIPTION /, <br />I I � G�_J <br />�Cle'uJ CO.uS7'(2�+CT1 0� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />WATER CLOSET ' � ( <br />BATHTUB � <br />LAVATOFiY (WASH BASIN) � / % I <br />SHOWER j <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />�������/ <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />NO. I'1YFE OF FIXTURE OR ITEM <br />� A!C -A/HANDL�NG 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 FIREPLACE � <br />GAS RANGE / <br />GAS PIPING //�/ <br />EXHAUSTFAN � <br />I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPUCATION 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 WHETHER SP'eCIFIED HEREIIJ OR <br />NOT. THE GRANTING OF A PERh11T COES NOT PRESUM1fE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGUfATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�� <br />J <br />� . . �% <br />