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�� <br />�`��fl <br />SITE ADDRESS <br />H I S �oSE i..>►4- <br />LEGA LOT N0. <br />✓ <br />PL�r�MIT APPLICATI� J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. M <br />s-��q r�od b►4 <br />BLOCK I TRACT <br />�D2.Gq <br />ur rnvnt uZS SIS—�Z� <br />k�4 9�zo'� � <br />TENANT NAME I CONTACT NAME V H NE <br />�e� 4zs-345--(038� <br />_ Clwwl �.-� c— I-t z.� 9/ ooL� <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />IT��� � <br />CONTRACT PRICE OF WORK <br />WOqK OESCRIPTION <br />uilding <br />PERMIT Cambinalion <br />TYPE Demolilion <br />Sprinkier <br />bv�, �� o� �-✓�� <br />NO. � TYPE OF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENTER <br />SINK (SERVICE/BARlMOP/ETC.) <br />OTHER <br />RMechanical <br />Plumbing <br />p Sign <br />n Addilion <br />�_� Alleralion <br />�_� New <br />LJ Repair/Meinl. <br />HEATSOURCE <br />Electric <br />Gas <br />Olhe� <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />(i� 72 S-� ��d�.' Q- ci� <br />NO. � TYPE OF FlXTURE OR ITEM <br />_ A/C—A/HANDLINGUNITS <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 />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAh71NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPL�ED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTRACTORS LAW 18.2 RCW AND 296200 WAC. <br />i,/����--- 9-y�az-. <br />Sig a ure ol OwnedContrectodAulhonzed Agent Date <br />/ <br />