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P[ �MIT a►PPLICATIC J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, �A�A 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�,k� �l �C�<� Cr�'I [�5= rn c`f <br />SITE ADD SS � PARCEL TAX I.U. # PER� 11 <br />����%�� �i ���il !�� I 1) fv,/l Qn.� /Y��7 rY��� m ���Z �� <br />LOT NO. <br />CONTRACTOq/, ,�/,{� <br />�%�iL�`� <br />PHONE �1���`��, <br />PRDPOSED USE OF BUILDING <br />_J �� <br />BLOCK T ACT �fJ�(�C.(Il� � � UI r� <br />� 11t4- � -� N � � �.1-� � !s � Fl � <br />ADDRESS ZIP <br />� (�^,i J�N ���D � �� /7i _ l0. �L��F-ll <br />CONTACTNAME <br />— ��i��,�-�N n7�Nl� �� <br />3U1��'L''S,..I�iC�ess���l�l �{��(�;r-f�� ziP <br />—rll�n� F1�liN��-G� (,c,#� a��3 <br />CONTRACT PRICE OF WORI( — <br />r <br />WORK DESCRIPTION � <br />�1i�_�:�e��� <br />NO. I il'PE OF FIXTURE OR ITEM <br />� <br />Butlding Mechanical <br />PERMIT Combination � Plumbiny <br />TYPG Demolilion U Sign <br />Spnnkler <br />o�% D-00—S O' <br />-rc uty rtC � d �� <br />PHONE <br />, <br />�-,�,,,�_, _ <br />CONTR. IICENSE M <br />�'����C3 � P �i <br />�//Z 9/��(..,� <br />�Addiiiori HEAT SOUR�E <br />Altera� on � Electric <br />New Gas <br />Fepair/hlaint. Oh,ar <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�a �'Y-�'�v�j� � r � <br />v <br />WATEH CLOSE <br />BATHi'UB� :� 7�'1,�."C l` <br />LAVATORI" (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />UISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLUW PREVENTER <br />SINK (SERVICE'BAF/MOP/[TC.) <br />N0. I TYPE OF FIXTURE OR ITEM <br />_ A/C — A/HANDUNG UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />= CLOTHES DHYER <br />J_ RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACElSTOVE <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />�r GAS PIPING <br />EXHAUST FAN <br />OTHER <br />.3 <br />I HERE�V CERITIFY THA71 HAVE FEAD ANO EXAMINED THIS APPLICATION AND KNOW THE SAI.1E TO BE TRUE AND COfiRECT. ALL <br />PPGVISIONS OF W WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHE7HER SPFCIFIED HERERJ OR <br />tJOT THE GRANTING OF A P RMIT DOES NOT PRESUME TO GIVE AUTHCRITV TO VIOLATE OR CANCEL THE PROI�ISION OF ANY OTHER <br />STATE OR LOCA� LAW FEG�TING CONSTRUCTIOY OR THE PEFFCRh1ANCE OF CONSTRUCTION. THAT I AM PUTHORIZED 9Y THE <br />OWNER OF TH157ROP[RTY %'(� PERFORM THE'NORK FCR IVHICN APPLICATION IS h1ADE AND I COMPIY WITH �i HE STATE <br />CONTRACTORS LAW 1827 RCN' AND 2962J0 WAC. <br />� la(-/C,. t�- <br />Date <br />�Z- <br />