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SITE ADDRESS <br />LOT NO. <br />TENANT NAME <br />PLRM�T <br />APPLICATiOid <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9D201 <br />425-257-8810 - FAX 425-257-8857 / p, , ` <br />I (N <br />l/ . S<<.� <br />PARCEI. TAX I.D. k <br />C� s �l / r oOc�z <br />� " " L- J <br />i <br />,� ��,�, .-7A , � <br />'NAME <br />� 3U/ <br />� �� • <br />PERMIT M <br />�30�'�O�/�.G. S�1', <br />PHONE <br />�,� <br />��✓%u-i P I �S�_� ��f /`-�'�sA,�,e, �! � s -.;Z 7'z -6 a 7 v <br />CONTqACTOR u���� �%, �� ��, �- ADURESS 21P CONTR. LICENSE N <br />.Qi,G� �jJn(?ti%'J.�.��. ,��irNL <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />�� l <br />CONTRACT PRICE OF WORK <br />WORKDESCRIPTION //-�-F��n'�✓ <br />ld,� . <br />I>G��c� �a � � <br />PLUMBING <br />NO. � TYPE OF FIXTURE QR ITEM <br />WATER CLOSET <br />B/ THTUB <br />LAVATORY (WASH BASIN) <br />SHC`NER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASIIER <br />LHUtJDRY TRAY <br />CLOTHES WASHER <br />Uf;INAL <br />DRINKING FOUNTAIN <br />FLOOfl DRAIN <br />BACKFLUW PREVENTER <br />SINK (SERVICE/BAR/ASOP/FTC.) <br />OTHER _ <br />Building MechaniCal Addition HEAT SOURCE <br />� Combinalion R�.( Plumbing WORK �R/� Iteralion R Eloctric <br />Demolilion u Sign TYPE G'j New �j'Gas <br />Sprinkler U RopaidMainl. L� Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURF OR REM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP • ' <br />UNIT HEATERS <br />CLOI'HES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FiREPLACE <br />GAS NANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBY CERITIFY TfiAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAA1E TO OE TRU[ AND COiii;ECT. ALL <br />PROVISIONS OF L1lVS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHE9 SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />iTATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHURIZED BY THE <br />OIYNER OF THIS PROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/. J [r -4�i / �t-''.Lx-r. — _ U ��2 - <br />Signawre of Owner/ContraclodAuthorized Agenl Date /-7 � <br />�/ <br />