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� <br />SITE ADDRESS <br />O I lo g�� <br />LEGA LOT NO. ZZ <br />DESC. �,� <br />OWNER <br />�l Men e�,�1�E I <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 - FAX 425-257-8857 <br />KlEN- <br />cor�rAncrori�_��� ConsTNc�ioN <br />PHONE �M�"` J � ��� �T�C <br />( 3Vo� 41.�- Zoo 0 <br />PROPOSED USE OF BUILDING <br />b'p��c -��.1 <br />CONTRACT PRICE OF WOpK <br />PARCEL TAl( I.D. A <br />O�bLQne,e,r <br />T1UCT <br />ADDRE.'S <br />i 58'L5 SE E�wnck <br />CONTACTNAME � <br />� LY� G� <br />aooAess �o ►og K p <br />S NDinON�15�� <br />mlding <br />PERMIT Combinalion <br />7YPE Demolition <br />Sprinkler <br />PEHMIT M <br />c �3o a-�5 <br />' PHONE <br />3,�0 �,�,a'���vo <br />CONTR. LICENSE � <br />wa°tez9c, KFw0.�Ro�beP <br />Machenicol <br />lumbing <br />Sign <br />�Addition <br />Alleralion <br />New <br />Repair/Mein�. <br />MEATS hdt• <br />Electric <br />Gas <br />Olher <br />CfTY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />WORKDE�CFiIPl.l� ii�WJ4`I �•'�CC��in�� -1- N,pUlNO� 1'��" � �'i�� <br />V <br />J <br />N0. � TYPE OF FIXTUHE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASIi DASIN; <br />SHOWER <br />KITCHEN gINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />NO. I TYPE OF FlICTURG OR REM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />META� FIREPLACE/STOVE <br />FIREP�ACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />1 HEREBY CERITIFY THAT I H�VE READ AND EXAM17INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Of LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 7HE GRANTING OF A PcRM1T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGUUITING CONSTRUCTION OR TFIE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPER7Y TO PERFORM 7HE WORK FOR WHICH APPLICATION IS i+IADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 29G.200 WAC. <br />L I �0103 <br />