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SITE ADDqESS <br />� � <br />LEGA LOT N0. <br />TENANTNAME <br />CONTBecrne c <br />F� cRMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wq g8201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. N <br />BLOCK � TRACT <br />CONTpCTNAME <br />✓C/Mpr �nv�in ,�1�qv 1{,H,e � ADDRESS �Ca1.�S Y�/i�— P <br />a' /�tK (.11. Sf. � <br />PHONE <br />N�s-a-bs-zzaa- <br />rn�ru5E0 USE OF BUILDING <br />CONTppCT Pp�CE OF WORK <br />Buiiding � Mechanical <br />PERMIT Comhination Plumbing <br />T�'PE Demolitlon Sign <br />Sprinkler <br />WORK DESCRIPTION R��y� v I rJ W <br />/IF �a�fa br�K�n ��Ic-f <br />Sr,.•�ie s�ro�S / I%e..f <br />�R� �o �Fw,� <br />N�• I TYPE CF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />S�NK (SERVIC E/B R/MOP/ETC.) <br />OTHER � F�� J r. h�r <br />PERMR N <br />Z- <br />PMONE <br />conrrn. uceNse r <br />� �d� I HEATSOURCE <br />WORK Alteration � ��y� <br />TYPE New Gae <br />RepeidMainL Other . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />/�lata(I <br />��w sv �.,�. h�4E�. .,�.�� d�.,:, v-�, <br />Na• TYPE OF flXTUpE OR ITEM <br />— rv� -wnnrvULING UNITS <br />_ FORCED AIR SYSTEMS <br />._ HEAT PUMP <br />_ UNIT HEATERS <br />_ CLOTHES DRYER <br />_ RANGEHOOD <br />_ WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPI.qCE INSERT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPING <br />_ FXHAUSTFAN <br />_I OTHER_,�_ <br />i hiEREBY CERITIFY THA71 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, qLL <br />PROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE pR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR TME PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO pERFORM THE WORK FOR WHICH APpLICATiON IS MADE AND I COMPLY WITH THE STATE <br />CONTRqCTORS LAW 18,27 q� qND/Y96.200 VJAC. <br />n . . / J <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />