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i �RMIT APPLlCAT�. JN <br />CITY OF EVERETT PERMIT SE�tV[CES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # PER%�T a�5 �/ <br />�lf ��/Ni�4- IOO�/iIS�LI L,(�O GlXI _W �� 1 `v � <br />LEGAL �� ���iq� BLK 416 D-00 - 8 15FT LOT 6 8 ALL LOT 7 BLK 416 <br />DESC. aP PMONE <br />OWNER n ADDRESS ' <br />/� �i-! n1� s <br />TENANT NAME <br />S /�, � ry <br />CONTFACTOR��n ��,� <br />�.� <br />PH NE <br />.�dv � 5 7-� 3�J <br />PROPOSED USE OF BUILDING <br />7� 1= <br />��} 1� G.�..t� tl � <br />o�r V�r�i� <br />CONTACTNA <br />��e �V '� ��t <br />��2. � / <br />PHONE <br />Ne S Zs�f� <br />S � ADOR�?i / �5 �� � Zi,� <br />CONTRACT PR�CE OF WORK U, p o[^ G <br />WORK DESCRIPTION <br />I ��\ 1 <br />Z�p�CONTR. UCENSE N <br />J J <br />sncc,N �� i <br />Building [] Mechanical .dIL! Addition HEATSOURCE <br />PERMIT � Combinalion �j Plumbing WORK I) Alleralion � Electric <br />TYPE Demolition U Sig� TYPE � New Gas <br />Sprinklar Repairl�daiN. Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />A-dd.v � -��-��s4-��� I-�-n�g <br />�Q..G rt.cn F � 5 � � SH~ � <br />S �1„�� � ��•�'� ��lutn <br />NO. � TYPE OF FIxTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEii <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />— I'fb S.f. <br />$ `t s.f <br />NO. I TYPE OF FI.`(TURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FiFEPIACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER_ <br />1 HEREBV CERITIFV 7HAT I HA'JE READ AND EXAMINE� THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PPOVISION9 OF L1W5 AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEPEIN OR <br />NOT. THE GFANTING OF A PER�AIT �OES NOT PRESUME TO GIVE AUTHORIN TO \90WTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCdL LAW RFGUTATING CONSTFUCTION OR THE PERPORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PEFFORM THE WORK FOR WHICN APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />��L <br />