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SITE ADDRESS <br />CR 3c� <br />LEGA LOT N0. <br />DESC. <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK- <br />WORK DESCRIPTION <br />CoNv�—rz� <br />,3F�ROa.�n <br />P��3MIT APPLICATIG.d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />PARCEL TAX I.D. M <br />RE v� <br />BLOCK TRACT <br />A�DRESS <br />ICONTACTNAME <br />ADDRE55 <br />Building D Mechanical <br />PERMIT � Combination [� Plumbing <br />TYPE Demolition �� Sign <br />Sprinkler <br />oau <br />TYPE <br />q ` It�-O �..- <br />PEFMIT n <br />k 2� - Do7 <br />21P PHONE <br />PHONE <br />ZIP CONTR. LICENSE N <br />n Hddition <br />F_� Alterahon <br />�! New <br />L� Repair/Meint. <br />HEATSOURCE <br />j7 Electric <br />B Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />E 1c.L=.S �itJ G— t.t.) �!Z K S t{� P i Ll !'Vl �!'£ � <br />�`� C��-� � 1 N sraYc� r� ER-r�r w�- q_C. s.� sr��� <br />� NO. I TYPE OF FI7(TURE OR ITEM <br />� � WATEF CIOSBT <br />i ,_ BATHTUB <br />/� LAVATORY (WASH BASIN) <br />I � SHOWER <br />i KITCHEN SINK S DISPOSA� <br />� DISHWASHER <br />', LAUNDRY TRAY <br />I � CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />� BACKFLOW PREVENTER <br />_ SINK (SERVICEiBAR/A70P/ETC.) <br />N0. I IYPE OF FIXTUflE OR ITEM <br />A!C —A/HANDUNG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTH� +7��Z �—gS � <br />I HERE�Y CERITIFY', HAT I HAVE R'tA0 AND [XAh11NED THIS APPLICATION AND HNOW THE SAIdE TO BE TRUE A��D CORRECT. ALL <br />PFiOVISiONS OF LiWS AND OFIDINACES GOVEFNING iHIS NPE OF WORK WILL BE COA7PLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PR[SUM11[ TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGUWTING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM1I THE `�VORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE S7ATE <br />CONTFACTORS lAW 1827 RCW AND 296.�C0 WAC. <br />SignaWre of OwnevContractor/Aulhor¢ed Agent Date / <br />!2 <br />