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F =RMIT APPLICATt )N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEUAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />Ct:�L' 9 �c Ey ��GaF <br />LEGA LOT NO. <br />DESC. �y � (Q <br />�1i 1�� FI EIv.�6RS�N <br />A �,� <br />BLOCK <br />PARCEL TAX I.D. # <br />,%oyqs�0om�c�S00 <br />TRACT <br />L/}NG-S <br />�c,3� 4 u,' <br />7 �-iG �o Z <br />M <br />7� <br />3-83� <br />TENANTNAME CONTACTNAME PHONE <br />�l^� i�VN:1F�ZSJfv I JsV�1 i-�F���zSclN L7,S�N7F-03c� <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE M <br />PHONE � LU ��� <br />PROPO:'ED USE OF BUIL�ING <br />gFR � � <br />CONTRACT PRICE OF— WORK�r/`7 r C� <br />Building D Mechanical <br />PERMIT COmbinati0n I ) Plumhing <br />TYPE Demolilion � Sign <br />Sprinkler <br />j� Addition HEAT SOVRCE <br />WORK ri Alteratian � Electric <br />IYPE RE New Gas <br />p RepaidhlainL Othar <br />CITY OF EVERETT LOCAL SALES TA:t CODE IS 3105 <br />WORK DESCRIPTION <br />�.6�+�C�'E CxLSf.Cn�tr u�tiS�t-E RO�� R��.J (2E�'I�GE, �.�;�i'�} 1v:-�,� <br />Ev�f��E��v�p�r�ugs�.S� EXPhnt� $�01�oDM� uE.W FOurWAij�r� 4N� <br />w�pu,5 tu GpafWE <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEPI SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHESIVASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV[NTER <br />SINK (SERVICE.��AR/MOP/ETC.) <br />OTHER <br />NO. I TVPE OF FIXTUHE OR ITEM <br />A/C — AlHANDIING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPL,4CE/STOVE <br />FIRE?Li�CE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBY CERITIFY'HAT I HAVE READ AN� EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WIVS AND ORIDINACES GOVERNING THIS NPE OF WOFK WILL BE COMPLIED WITH WHEfHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGUI�ITING CONSTPUCTION OP. THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED DY THE <br />OWN[R OF THIS PFiOPEFiN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I CGMPLY WITH THE STATE <br />CONTRACTORS L.1W 1827 RCW AND 296200 WAC. . <br />7 / rZ � .`)� <br />��z <br />