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SITE ADDRESS <br />se <br />LEGA LOT N0. � <br />D[SC. <br />OWNER <br />L�-c'�"���•, <br />1J,• �. . cD.� <br />TENANT NAME ��— <br />P�riMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />���s�_ ��,� <br />BLOCK <br />IJU�.i�—C7� <br />/ S�-c/%•- <br />� %�7-7 L' <br />Srv� <br />PP,RCEL TAX I.D. M <br />x�,s 5'r�ao�o <br />TFAGT <br />+�' ., ,� �' c <br />AUORESS <br />'� U i '/O �// <br />CONTACT NAME <br />�ca <br />CONTRACTOR � �� t ���� l/ ,Sc�,I-r ADDRESS <br />�rhLD�Me-..T� �e�.�-, <br />PHONE <br />s�F-rK e 5�9�^" � <br />PROPOSED USE OF BUILDING �Building Mechanical <br />PERMIT � Combination Plumbing <br />TYPE Demalition Sign <br />Sprinkler <br />9 <br />/'-[�/`f <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION J,�'/ <br />NO. I TYPE OF FIXTURE OR I1�EM <br />_S WATER CLOSET <br />� BATHTUB <br />� LAVATOFiY (WASH BASIN) <br />_� SHOWER <br />.� KITCHEN SINK 8 DISPOSAL <br />_..c,,� DISHWASHER <br />Gr LAUNDRYTRAY <br />Z CLOTHES WASHER <br />URI�:AL <br />DRINKING FOUN i 41N <br />FLCOR DRAW <br />BACKFLOW PREVENTER <br />_ SWK (SERVICF/BAR/MOP/ETC ) <br />OTHER <br />2a�a- <br />3U <br />� ��� - 6/; <br />PEHMIT X <br />����� � <br />'."�''PE�--�— <br />iONE�.� � C--23�•-6 Z <br />��r/r�, t,c/Sz /�f�3_���j <br />� PHONE <br />�/t.s Y�3z-Gz90 <br />21P CONTR. UCENSE M <br />Atldi,'on <br />WORK AlleraL�n <br />TYPE ew <br />Repair/Mnint. <br />HEATSOUpCE <br />��eciric <br />as <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. � TYPE OF flXTURE OR ITEM <br />A/(: -AIHANDLING UNITS <br />FORC[D AIR SYSTEMS <br />HEAT PUMP ' ' <br />UNIT HEATERS <br />CLOTF!ES DRYER <br />RANGEHOO� <br />WATER HEATER <br />MF.TAL FIREPLACFJSTOVE <br />FIREPLACE INSEP � <br />GAS FIREPLAGE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHEA <br />• <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COh1PLIE0 WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AD:Y OTHER <br />STATE OR LOCAL LAW REGULATING CONSTPUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OlM1'NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY `,YITH THE S"ATE <br />CONTAACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�/�� Z � <br />Date � <br />