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:� <br />PERMIT <br />APPLICATION <br />CITY OF EVERETT PERMI 1' SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />/ o /%%vK %c. rEo Qc..�la. <br />LEG�L LOT N0. BLOCK <br />DESC. t� L nn�lJ - n � <br />TRACT <br />PARCEL TAX I.D. H <br />�i/7 �O� �s� <br />REP/.AT D.� �o y <br />PERMIT q <br />�F_S v• /`�EfJ2.Saci //��% %�l�c�iCi�r6o Uc-uD. �/��43 �%�S•�.SS��7oS8 <br />TENANTNAME I CONTACTNAME PHONE <br />�.�� <br />CONTNACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />GA� � <br />CONTRACT PflICE OF WORK <br />WORK DESCHIPTION <br />/�,=m ma<:�- ��� <br />AUDRESS <br />�uilcling Meclianical <br />PERh11T Combinalion R Plumbing <br />TYPE Denlolilion � Sign <br />Sprink��f <br />Z� 2 ._ <br />�i',75 -BSS- <br />ZIP CONTH. UCENSE M <br />j� Addition F1EAT SOURCE <br />WORK �fAlleralion R Electri: <br />TVPE H, New �j Gas <br />IdlRepair/MainL �J Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />F�s;,,�y �A�� „�� R ��2�yE. <br />NO. I TYPE OF FI%TURE OR ITEM <br />WAl"[R CLOSET <br />DATHIU� <br />I_�VATORY (WASIi ��SIN) <br />SIIOWER <br />KITCH[N SINI< 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTR�Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAI�J <br />l3ACKFLOW PREVEfJTER <br />SWK (SERVICE/OAR/MOP/ETC.) <br />OTIi[R <br />NO. � TYPE OF FIXTURE OR ITEM <br />NC - NHANDLING UNITS <br />FOFCED AIR SYSTEMS <br />HG/1T PUMP <br />UNIT HEAT[RS <br />CLOTNES DIiYER <br />RANGEHOOD <br />WATER HEATER <br />M[TAL FIR[PLACE/STO' �E <br />FIREPLACE INSERT <br />G�5 FIREPIACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEfiEDY CERIiIFY THAT I HAVE RBAU AND EXAIdINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF U1W5 �ND ORIDINACC-S GOVERNWG THIS TYPE OF WOFK WILL BC- COh1PUED WITH WIiGTI I[R SPECIFIED HFREIN OR <br />NOi. TH[ GRANTING OF � PERMIT DOES NOT PR[SUh1E TO GIVE AUTHOFlI IY TO VIOLATE OR GANCEL TfiE PROVISION OF ANY OTfIER <br />STATE OR LOCAL LAW R[GULATING CONSTRUCTION OR THG PERFORMANCE OF COPISTRUCTION. THAT I AM AUTHORIZ[D OY THE <br />OWN[R OF il IIS PROPERTY TO PERFORM TI1E WORK FOR WHICIi APPLICAiION �S MADE AND I COMPLY WIThI THE STATE <br />