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il <br />� 0 0 S A; <br />SITE ADDRESS <br />' a� S <br />LEGA LOT NO. <br />�/ /;/io� <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />`rERMIT APPLICAT �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />. . Il25-257-8810 - FAX 425-257-8857 <br />s i � �-v <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />�l�'ll �lo� l5/� <br />I:ONTACTNAME <br />PROPOSED USE OF� ILD� <br />rJl /�� � } �/— <br />CONTRACT PRICE OF WORK <br />ADDRESS <br />T <br />PEPMIT R <br />C c�3��-F-o� <br />ZIP PI10NE <br />� 3Go�F�s� <br />PMONE <br />ZIP CONTR. LICENSE M <br />Buildi�g Q Mechanica! Addillon HEATSOURCE <br />PEHMIT R Combination u Plumbing WORK � Alleration � Electric <br />TYPE Demolition Lj Sign IYPE New Ges <br />B Sprinkler (k ol heeds) Repair/Maint Other <br />G�T ..n n�- � CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />WORK �ESCRIP710N /� <br />�m(l-�—e- �� - ' ��L�„� �� c � �`'''`�'� <br />� <br />���.���-'�''�/� <br />.,� ��..e,.�.. �ucr.HnNir.n� <br />NO. I TYPE OF FIXTURE OR ITEN, <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />I:ITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <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 OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />�CLOTHES DRYER <br />RANGEHOOD <br />WATFR HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />G:1S FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />� EXHAUST FAN � � <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EY.AMINED THIS APP:ICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAINS ANO ORIDINACES GOVERNING THIS NPE OF WG�iK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE �R�NTING OF A PERMIT DGES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEF OF THiS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE ST�1TE <br />GONTR CTORS LAW 1827 RCW AND 296200 WAC. <br />,!r�� _��.,� � .� �, Z . Z �S o � <br />(� U 3 ��--oc�7 <br />