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� <br />� <br />SITE ADDRESS <br />LOT NO. <br />DESC. <br />P:.RMIT APPLICATIL.� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857� � <br />� `I37t��- <br />BLOCK TRACT <br />lo - b� <br />�/ 1 <br />,C--� J� `/ 7.��` LC. L�� �, L��` `1���`- 3 , <br />TENANTNAME CONTACTNAME PMONE <br />� <�il I ���,�,��� �� `"��� ��^�;� �/).�`( <br />CONTRACTOR /JnnM����� A�4RESS <br />/'-'� ��. <br />PNONE /�F� ��,�. <br />1� <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />j�) Building <br />PEPMIT [� Comhination <br />TYPE E�-Demolition <br />U Sprinkler <br />�� <br />��,+,9-1 -8�� �,c�G,�;e�-8-� <br />NO. I TYPE OF FI7(TURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKI4G FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/MOP/[TC.) <br />OTHER <br />Mechenical <br />Plumbing <br />Sign <br />Z1P CONTR. IICENSE 1 <br />� <br />� <br />� <br />� <br />Addilion <br />Alteralion <br />New <br />Repeir7Maint. <br />HEATSOURCE <br />Eiectric <br />Gaa <br />Other <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FlXTUflE Oii ITEM <br />A/C — AlHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE REAO FND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEfl :,PECIFIED HEPEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PFOVISION OF ANY OTNEH <br />STATE OR LOCaL LAW REGULATING CONSTRUCTION Ofl THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN� I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />Signawre of OwnerlConiractoriAu�horized Agent ate <br />