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P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS /y �usc ��` � PARCEL TAX I.D. A P MI7 a <br />OUs o Z3o1 J2�J5-Ol <br />IEGA LOTNO. BLOCK TRACT (/1aSf h�IF o� '�lraf Lj, Pecks �y✓�wT/�c% �tcrd/+� �o <br />DESC. /.. �/J �� � Pl.i �r.r�j l....../../ .: V��IU eG Pl�i� A 9S �noh�.h�1/ ��. G✓n' <br />TENANT NAME <br />CONTRACTOR <br />PHONE �zS_ 2S%- y00U <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Co. LCC 3Gal �'.16y /��e <br />I CONTACTNAME <br />A�ORESS <br />,3Gol <br />H G✓� �BZoI yzs-ZsS-y <br />PHONE <br />ZIP CONTF. LIGENSE t <br />�ol6y ���if �� 9ezoi �oc�itiocvZv,rg <br />� Building � Mechanical <br />PERMIT Combinalion Plumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />WORKDESCHIPTION N�� �j,�ra� <br />NO. � TVPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SNOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHE9 <br />LAUNDRYTRAY <br />C�OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN'fEA <br />SINK (SERVICE/8AR/h10P/ETC.) <br />OTHER <br />NJ� <br />�Atldi(ian <br />Alteralion <br />Ne�v <br />RepairRdaint. <br />I7tnI Swn�c <br />Electric <br />�� Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />;�i�c � 22l'G <br />MECHA� <br />NO. I TYPE OF FI%TURE OR ITEM <br />A!C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />NETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIP�NG <br />EXHAUSTFAN <br />OTHER <br />N/A <br />I HEFEBY CERITIFY THAT I HAVE READ AND EYAMINED THIS APPUCATION AN� KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDII�ACES GOVE(;NING THIS TYPE OF WORK WILL BE COMPLIE� W�TH WHEiHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO G�VE AUTHORITY TO VIOWTE OR CANCEL THE PROV�SION OF ANY OTHEF <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE LYORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />—h—� ,� � �b'� S- lv- D� - ��� <br />�.1 b�::--`� '?� <br />