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� <br />SITE ADDRESS <br />K2a <br />LEGA lOT N0. <br />D[SC. <br />TENANTNAME <br />� •ERMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />u <br />BLOCK � TRAC7 <br />PARCEL TAX I.D. N <br />NAME <br />PERMIT k <br />PHONE <br />Sa��.� I cl��.h� lQrm�fa�r '-/.t53s3-9396 <br />CONTRACTOR ADDRESS ZIP CONTR. LlCENSE N <br />�A��$ �S-F�t��a�:��` �110 �jrouc��nJ E ut�cfl %f?O/ DAUCSI'IOSONS— <br />PHOAE <br />4}S � 255- �/G�I <br />PROPOSED USE OF BUILDING <br />.$ F F� <br />Building Mechanical <br />PERMIT R Com6inalion Plumbing <br />TYPE g Demoiition Sign <br />Sprinkler <br />CONTRACT PRICE OF WORK �% :j 00 D <br />WORK DESCRIPTION <br />Ins-iu�� P��r�� <br />, <br />F�«pI�« � H�� <br />Addition MEATSOURCE <br />WORK Alteraqon n{,� Elactric <br />TYPE New �Q Ges <br />Repeir/Maint U Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />�c� !�-C�S t;rc��att a%oltJ�•t�V i'un1�. a' <br />NO. � TYPE OF FlXTURE OR REM <br />u -c� ,r ^�-u .� � . <br />W�TER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL V PREVENTER <br />SINK (S�riVICE/BAF1/MOP/ETC.) <br />NO. I TYFE OF FlXTURE OR ITEM <br />A/C - A/HANDLING 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 />EXHAUST FAN <br />OTHER <br />�� <br />I HERE9Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PPOVISIONS OF LAWS AND CRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GR?NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOIP.TE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOC:+L LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFACT6}lS LAW 1827 RCW B�PlD 296200 WAC. <br />