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S�TE ADD�R,E/SS <br />3��� WB N�D� A <br />LEGA LOT N <br />DESC. �$ 2 <br />OWNER <br />syr 6 Ph� p� <br />TENA►fT NAME <br />CONTRACTOR <br />PMONE / J/n 1�� <br />�/ I.l' J <br />PROPOSED USE OF BUILDING <br />Storage <br />CONTRACT PRICE OF WORK <br />��RMIT APPLICATI�. N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK TRACT <br />Z ���M4 <br />WORK UESCRIPTION •Z �� X 2O <br />� NO. <br />TVPE OF FlXTUHE OH ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDFY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. +1 <br />NAME <br />Building Mechenicai <br />aERMi7 Combination Plumbing <br />TYPE � Oemolition Sign <br />u Sprinkler <br />PEnR��MIT x '/ <br />F-� � �Y_ � � <br />���ti DIK ooz Doo <br />ZIP PHONE <br />WA . 9szoi ly2�zse-s <br />t—PHONE <br />LP CONTR. UCENSE � <br />AdOilion <br />Alterotion <br />New <br />RapaiNMei�t. <br />HEATSOURCE <br />(� Eiectric <br />B Gea <br />Other <br />CITY OF EVERETT LOCAI SALES TA% CODE IE 7105 <br />S�Eorac�¢ bui Id� .�g <br />N0. I 1YPE OF Fll(TURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER IIEATER <br />METAL FIREPLACE/STOVE <br />fIREPL4CEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERI7IFY THA71 HAVE REAO AND EXAMINED THIS APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4WS AND ORIDINACES GOVERNING TMIS TVPE OF WORK WILL BE CUMPLIED WITH WMEfHER SPECIFIED HEREIN OR <br />NOT. THE GNANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORIN TO VIOLATE OH CANCEL THE PROV�SION OF ANV OTHER <br />STATE OR LOCAL Ll�W REGULATIN(i CONSTqUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOHIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK POR WHICH APPLICATION IS HADE AND I COMPLV WITM THE STATE <br />CONTRACTORS lAW 18.27 RCW AND 296.200 WAC. <br />9+�P `�� P„P�,,v,�. � a-o � <br />