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( <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV'ERETT, WA 98201 <br />425•257-8Fi10 - FAX 425-257-8857 <br />SITE APDRESS PARCEL TAX I.U. p <br />PERMIT� .a, <br />U Z.7 S f �SE OL'� _ �L.�) <br />LEGA LOTNO. BLOCK TRACT <br />DESC. <br />OWNER AODRESS <br />N 3ZvU ZIP PHONF�,2i�?S'7J2Y.'. <br />c, �� o F C��.t �vGaz ��.�i.;�,-rs <br />cF14,,z s,". E�.�,z�;, u,a qdzu� <br />TENANiNAME I CONTACTNAME o <br />HOiVE <br />Ewf'c� H'/�i,✓i. c�z�-�..� /il�c1�S4LG /J. /Zo.gr,.�so,t/ Cy1S) 2s 7�z�ld <br />CONiRACTOR ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONiR.4CT PRICE OF WOpK <br />WORK DESCRIPTION <br />� Building <br />PERMI7 Combina�ion <br />TYPE Demolilion <br />Sprinkler <br />Mechanical <br />Plurnbing <br />Sign <br />�Addilion <br />Alleretion <br />New <br />Repair/Maint. <br />NEATSOUpCE <br />Electric <br />Gas <br />Other <br />CITV OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />/nlS:.�«.9: io.•/ C�r" /1 T��>fat�-�Y Cv.�S.-�7ucTro..l i.Lt�c.E,? <br />L-S/�6l%/Jlfi.� ���K�aJ•%�( %�i7%� QT /✓C�CY✓//.+cIZ ZQ�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ wAIEFCLOSET <br />_ BATIiTUB <br />._ LAVATORY (WqSH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK & DISPOSAL <br />_ DISIiWASHER <br />_ LAUNDRYTRAY <br />._ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP.�ETC.) <br />_ OTHER <br />NO. I TYPE OF FIXTURE JR ITEM <br />_ rv� —AiHANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEATPUMP <br />_ UNIT HEATERS <br />_ CL07HES DRYER <br />_ RANGEHOOD <br />_ WATER HEATER <br />_ METAL FIREPLP.^E/STOVE <br />_ FIREPLACE INSEHT <br />_ GAS FIREPLACE <br />_ GAS qANGE <br />_ GAS PIPING <br />_ EXHAUSTFAN <br />_ OTHER <br />I HEREBV CERITIFY Tliq' I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE Of WORK WILL BE COMPLIE� WITH WIIETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DO[S NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY O7"HEF <br />S7ATE OR LCCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAI" I qM AUTHORIZED BY THE <br />OWl�ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.2�`iCW AND 296200 WAC. <br />. , �l ,. / <br />:o OZ <br />�� <br />