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-. ----- -- - - ---- <br />. <br />F��RMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257•t1810 - FAX 425-257-8857 <br />SITE ADDfiESS <br />jZC,�� ';J �?�i�� 1��L <br />LEGyI LOT NO. BLOCK <br />DES" <br />OIYNEP <br />� <br />_•;.�\�..�: ���f''�'�,,.cv-� <br />TENANT NAAIE <br />CONTR4CTOR <br />PNONE <br />PROPOSEO USE OF BUILDING <br />Sf--� <br />COffTRAGT PRICE OF WORK <br />i 1YORK OESCRIPTION <br />t�V l�.-'D <br />TRACT <br />Sz�l <br />PARCEL TA% I.D. M <br />S � 3 «� �t�� <br />CONTACTNAME <br />Cy�.��..� Y�coi c,-�c,1 <br />ADORESS <br />Bwlding Mechanical <br />PER611T R Com6mnlion R PlumDing <br />TYPE D Domolilion D Sign <br />U SDnnklor <br />NO. I TYPE OF FIXTURE OR REM <br />'�vATER CIOSET <br />Ba;HTUB <br />L:>S'A�GRV (WASH BASIN) <br />SHO�YeR <br />KITCNEN SINK 8 DISPOSAL <br />D!SITY�aSHER <br />LAUNDRV TPAY <br />CLOTMES WASHER <br />URINAL <br />DFiINKING FOUNTAIN <br />FL�OR DRAIPJ <br />BACKF�OVJPREVENTER <br />SINK �ScRVICE'BARlMOP/ETC.) <br />PEFiM1T � <br />C�zc�S-c� �/ <br />`� �`'� �-(7 5 �-S� _3S� <br />PHONE <br />�(Z5 Z5�' 3S � <br />ZIP CONTH. UCENSE � <br />AUA�!wn HEAT SOURCE <br />WORK Aqmnuon R Electr�c <br />NPE Now �.,{ Gns <br />RpO�mhla�nl lJ Olher <br />CITY OF EVERETT IOCAL SALES TA% COOE IS 7105 <br />� � 1'� '�� K- •�4d�LC. <br />TYPE OF FI%TURE OR ITEM <br />A�C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HE�TERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METALFIREPLACFJSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPI�IG <br />EXHAUST FAN <br />� NEAEBV CERIiIFY 'HAT i HAVE READ AND EXAIAINED THIS APPIICAi�ON AND KtJO'.Y THE SAIdE TO BE TRUE AND CORRECT. ALL <br />�P�YISIG��S CF LAY75 �� A ORIDINACES GOVER��ING THIS TYPE OF YJOiiK WILL BE COIdPLIED WITN WHETHEP SPECIFIED HEREIN OR <br />•�OT rHE GRnn71HG OF a PERIdIT �OES r�OT PRESUhtE Tq GIVC AUTHORI7Y TO VIOLaTE OA CA�JCEL THE PFOVISION OF ANY OTHEii <br />� i ATE OR LOCAL LA'1l PEGULATING CCHSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTHORIZED 6Y THE <br />:',4t1EH GF TMIS PPCPEPi/ TO PERFORId i NE'NOFK FOR WHICH APPUCATION IS MADE AND I COMPLV WITH THE STATE <br />CGh i�ACTORS L1Y!' B 27 FCW AND 295 2C0'llAC. <br />�y�y���k,�;. �t�r�,.ti��_ S-l"�� v�- <br />S�gna� re o eu omractor/Authonzed Agent �� �� o / <br />�I Z <br />