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P�RMIT APPLICATIa`iV <br />��ITY GF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-25i-8857 <br />SITE ADDRESS <br />4 —aTC S <br />IEGA LOT NO. <br />DESC. O M. Se..-r�� HA�f�I <br />OWNER <br />FlN� �• Ivt1. <br />TENANTNAME <br />SAni <br />CONTRACTOR <br />PHONE / /�_ p p � <br />l� M..� <br />PROPOSED USE OF BUILDING <br />( A�ACE <br />CONTRACT PRICE OF WORK <br />WORKDESCRIPTION ��� <br />EJt2c� <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT <br />'7 S r A7E S'r <br />CONTACT FOR PERMIT <br />S�An� <br />ADDRESS <br />Q� Building D MechaNcai <br />PeRM17 I ) Combination [� Plumbing <br />'fYPE Demolition U Sign <br />B Sprinkler <br />� A2 AGC <br />NO. I TYFE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (VJASH BASIN) <br />SHOW ER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BARIMOP/ETC.) <br />OTHER <br />SIAGC� <br />��Xa� <br />PERMIT # <br />li2 S- <br />��A qP?o I 33"t - <br />PHONE <br />Irl�- '74V-69�S <br />1 ,� �-��. � <br />ZIP CONTR. LICENSE K <br />I�VUIYVI� <br />AlleraUon <br />New <br />Repair/Maint. <br />HEATSOURCE <br />Eledric <br />Gas <br />Other <br />arr oF eveRErr wcn� �n�.r� 1/�l� HVYC N.� �v.� <br />$ I�,ey <br />NO, I TYPE OF FIXTURE OR ITEM <br />A/C - AIHANDLING UNi75 <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />i <br />1 HEREBY CERITIFY THPT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WCRK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />rnN7RACTOi�S LAW 18.27 RCW AND 296.200 WAC. <br />6 <br />�!L <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />