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P�. RMIT APPLICATIQ.�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />50? u��r <br />LEGA LOT NO. <br />DESC. AI S�n I' <br />i � v, ��.�.�.,...�ti <br />TENANTNAME <br />CONTRACTOR <br />PHONE O��e` <br />PROPOSED USE OF BUILDING <br />SF� <br />CONTRACT PRILE OF WORK <br />WORK DESCRIPTION <br />ADP `TZ `'4'•iT <br />NO R�D�TiOntAl- <br />PARCEL TAX I.D. �t <br />fE 4`i -10-OI <br />BLOCK TRAC? <br />[l0 5� 5 P �. <br />ADDRESS <br />502 I.�ETMof'� <br />CONTACTNAME ��� <br />� <br />ADDHESS <br />—O �Q3 <br />Building D Mechanical <br />PERMIT R Combination B Plumbing <br />TYPE D Demolilion Sign <br />�� Sprinkler <br />coai <br />PERMIT M <br />Zo� 'fZS 2�2 a870 <br />PHONE <br />ZIP CONTR. LICENSE N <br />�Addition <br />Alteration <br />New <br />FepairRdaint. <br />HEATSOURCE <br />�Electnc <br />Gas <br />Other <br />CITY OF EVERETT IOCAL SALES TA% CODE IS 3105 <br />T� TNC SovTt-1 51 DG <br />Pct�M$�iJC6� � t-FVAG. <br />NO. I 1"YPE OF FIXTURE OH ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 OISPOSAL <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />OF TK� RESIDi IJC.E <br />MEGMAIVIGAL <br />NO. TYPE OF FIXTURE OR ITEM �/�'( <br />I— <br />� <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />riEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIFiEPLACElSTOVE <br />FIREPLACE �NSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HE'nEBY CERITIFY THAT 1 HAVE RC-AD AND EXAMINED THIS APPLICATION AN� KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS GP L1W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH V/HETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEFMIT OOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGULATING CONSTFUCTION OFl THE PERFORMANCE OF CONSTRUCTION. TFAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PRCPERTY TO P[RFORM THE WORK fOR WHICH APPLICATION IS MADE AND I COMPL.Y WITH TNE STATE <br />CO RACTOPS L1W 1. 'N PND 29fi.200 WAC. <br />S naWreo Owner/CoNractoriAuthonz Agent Date �/a <br />