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SITE ADDRESS <br />a3z� ti�� �o <br />LEGA LOT NO. <br />DESC. <br />�-( ! C�'1Q <br />TENANTNAM� <br />P�RMIT �PPLICATI(.,N <br />CITY OF EUEf,'ETT PERMIT SERVICES <br />3200 CEDAR S'TREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX �.D. # <br />11 <br />BLOCK TRACT <br />A�ORESS <br />� .�3a� �.�c ��,a �� � <br />� CONTACTNAME� <br />CONTPACTOR <br />cr-t rt�n r�c r Nc <br />PHONEt� C r- <br />—1 Z�j �S I iO�c.� �D 1c� <br />PROPOSEO USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />14�5 i3�oA0wAY �� I I <br />Building Mechanical <br />PERMIT g Combination � Plumbing <br />TYPE D Demoliti0n Sign <br />U Sprinkler (a ot heads) <br />WORK DESCRIPTION p� �,� � ` �I �� � � <br />►� rV <br />Insfia I �/5 <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 />DISHINASHER <br />LAUNDRY TRA'/ <br />_ CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTHER <br />P�RMI� <br />�'r� d D �' �/ 3 <br />' 2oco y8�! 595� <br />PHONE <br />RO ZC I CONTR. LICENSE M <br />CNNr��Oq52'} <br />Addition HEATSOURCE <br />WORK Alteration Electric <br />TYPE Naw �Gas <br />Repair/MainL �� Other <br />CITY OF EVERETT LOCAL 3ALES TAX CO�E IS 3105 <br />NO. � TYPE OF FIXTURE OR REM <br />A/G — A/MANULING UNI I S <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEfl <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHA�STFqN <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAIdINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COfiRECT. ALL <br />PROVISIONS OF IAWS AND ORID�NACES GOVERNING THIS TYPE OF WORK WILL BE COM1IPLIED WITH WHETHER SPEGFIED HERcIN OR <br />NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTFUCTION. THAT I Ah1 AUTHORIZED BY THE <br />nWNER OF THIS PROPERTY TO PERFORAI THE WOFK FOR WHICH APPLICATIO� IS MADE AND I COAIPLY WITH THE STATE <br />!� ITRACTOr7S LAW iB.27 qCW AND 296200 WAC. <br />� I�t�l��� �� f��z ���n.;1, c l���r�0�, <br />