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F�:RMIT APPLICATII,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9�: �1 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS � � <br />�s �6 s. 3 �� � <br />LEl3A LOTNO. <br />oES�. �� . 3 _ <br />OWNER <br />Lc'nh� d. �e{,y� <br />TENANTNAME � <br />CONTRACTOR <br />BLOCK <br />Pr10NE U�,n � <br />PFIOPOSED USE OF BUILDING <br />CONTHACT PqIGE OF WORK <br />WORK OESCRIPTION <br />�"GI' I�OfN� <br />� <br />NO. I TVPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_ SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />_ LAUNDRYTRAY <br />_ _ CLOTHES WASHER <br />___ URINAL <br />_ DRIMKING FOUNTAIN <br />FLOOA DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />PARCEL 7AX I.D. k <br />;o�3^r033 O�,Z <br />TRACT <br />� wc . l <br />ADCRC-SS <br />���� i S. �� ve <br />ICOPT�ACT NPME <br />ADORESS <br />8uilding Mechanical <br />PERMIT Combinalion R Plumbing <br />7YPE Cer nlit�on ❑ Sign <br />Sprinkler <br />�7�ZO.S -fl�� <br />,_ PERIAIT M (h <br />�us I ��: <br />2�P P ONE <br />�8,?�3 y�5 3a3-o.73G <br />PHON <br />ZIP CONTR. LICENSE M <br />Adtlilion <br />WORN Allera�ion <br />TYPE New <br />Repair/Maint. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />NO. I TYPE OF flXTURE OR ITEM <br />H/l.—PJFIANULI:VG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DF, � ?R <br />RANGEHOOD <br />WATGR HEATER <br />METAL FIREPLACElSTOVE <br />FIF�PLACE INSERT <br />rA i FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THA71 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORREGT. ALL <br />PR0�11510N5 OF LAWS AN� ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />?IOT. Tt1E GRANTING OF A PERI.IIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE O OCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSI"RUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER F THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />