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� P�..RMIT APPLICATII.�V <br />�M�` CITY OF EVERETT PERMIT SERVICES <br />-�•¢" 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. N <br />�4�1-(1 �Uc.K�� Fv�� ���4c'7R zo <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />OWNER AODiiE55 <br />�,ARoi..i'1�+ i�. Jl1r���S ��Nf.,:-r Rt.f. <br />TENANTNAME � CONTACTNAME <br />CONTRACTOR <br />C'J l,v �\t � <br />PHONE <br />i PROPOSED USE OF BUILDING <br />i Sr � <br />i <br />ADDRESS <br />Building Mechanical <br />PERMIT R Comt�inalion R Plumbing <br />TYPE D Demolition p Sign <br />�� Sprinkler <br />CONTFACT PRICE OF WORK,X ' i� � O <br />Y� <br />PERMIT e <br />�i � ) �-/'�.JO <br />ZIP PHONE <br />�I,�.S �.5� 4`%�9 <br />PHONE <br />ZIP CONTR. LICENSE q <br />j'") Addition <br />�. � Alteration <br />�j New <br />�� Repairil.taint. <br />HEATSOURCE <br />�] Electnc <br />r� Gas <br />U Other <br />�_ �-� ' I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />jWORK DESCRIPTION � � � <br />� R� (�ua c`z �x istitvl, D�u� v� � i� ut,w AN7 ��titP��v�� <br />NO. I TVPE OF FIXTURE OR ITE1d <br />WATER CLOSF. i� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWFR <br />KITCHEN SINK 8 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 ITEM <br />A!C — A/HANDLING UNITS <br />fORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOQD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSEAT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE R&10 AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF L.1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COIdPLI[D WITH'.YNFHER SPECIFIED HEREIN Of7 <br />�10T. THE GRANTING OF A PERMIT DOES NOT PR[SUA1E TO GIVE AUTHORITY TO VIOLITE OR CANCEL THE PROVISION OP ANY OTHEH <br />STATE OR LOCAL LAW REGULATWG CCNSTRUCTION OR THE PEPFORMANCE OF CONSTFUCTION. THAT I AM AUTHORI'<ED BY THE <br />01'JNER OF THIS PFOPEPN TO PEPFORM1I THE WORK FOFi WHICH APPLICATION IS tdADE ANC I COMPLY WITH THE STATE <br />CONTRAC af±S LA1N 1827 RCW AN� 296.200 WAC. <br />I --- -��== v. — �D P�K O � <br />SignaWre oi uwnevcon« acwnHumonzea ngem ��,_ �/ <br />I �Z <br />I <br />� <br />