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PERMIT APPLICATION <br />���!� CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />/)r ��'lZ �/J��//)l �� <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT M <br />g9i; �7NR� W. 39Z3- 000_ oio - oGoo I C�a�a-o��, <br />LO7 NO. � BLOCK I TRACT <br />DESC. <br />C'��1U�u.E .HdM e5 ZNG`• 3 Z2% W�o2��1✓��7D <br />TENANT NAME I CONTACT NAME <br />CONTHACTOR pDDRESS <br />C (LA��VI�� N�m�� �ti'� <br />PHONE 32Z9 WeTmcrt�+!'✓E �� <br />�F ZS- 33 '7 - 9 �`7 9 <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WOHK <br />WORK DESCRIPTION <br />/�/�U/ G1�Nsi . <br />/'�3� ,�:F <br />o� <br />NO, I TYPE OF FI7Ci URE OR ITEM <br />3 WATER CLOSET <br />2 BATHTUB <br />� LAJATORY (WASH BASIN) <br />� SHOWER <br />I KITCH[N S�NK 8 DISPOSAL <br />� DISHWASHER <br />LAUNORYTRAY <br />� CLOTHES WASHER <br />URINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR ORAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICEi8AR/MOP/ETC.) <br />Buiiding Mechanical <br />PERMIT � Combiretion � PlUmbi�g <br />7YPE Demolit�on Sign <br />Sprinklei <br />ur rn�nc �/ns <br />Llg2ol 33rJ— 90�/9 <br />PHONE <br />ZIP <br />98�� <br />CONTR. LICENSE M <br />�11�V/ll �/3KS <br />Addi�ic�t I ME..i SOURCE <br />Alteralion Electric <br />New � Gas <br />RepaiuMaim. Other <br />CITV OF EVEREIT LOCAL SALES TAX COOE IS 3105 <br />1.0. I TYPE OF FU(TURE OR ITEM <br />A/l: — A/MANfJLINCi UNITS <br />_L FORCED AIR SYSTEMS <br />HFATPUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGE HOOD <br />_L WATE� HEATER <br />_ METAL FIREPLACE/STOVE <br />' FIFiEPLACE INSERT <br />� _I GAS FIREPLACE <br />GAS RANGE <br />�GAS PIPING <br />_ EXHAU3T FAN <br />_ OTHER <br />I RERE9Y CERITIFI THA71 HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF W WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERM�T GOES NOT PRESUME TO GIVE AUTHORI?Y TO VIOL,ITE OR CANCEL THE ARJVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGULATING CONSTqUCTION OP, THE PERFORMANCE OF CONSTRUCTION. THAT � AM AUiHORIZED BY THE <br />OWNER OF iH15 PFOPERTY TO PERFORM THE WORK FOR WHIGH APPLICATION IS h1A0E AND I COMPLV WITH THE STATE <br />CONT(7ACTOR�S LAyJ 18.27 RCW AND 296.200 WAC. <br />— / `I - O <br />/Z <br />