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P'cRMIT APPLICATI�,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />//D� SlJM NL'7P CJ+�"E <br />LOT N0. I BLOCK � TRACT <br />/2A�P� S�NuU< <br />TENANTNAME <br />CONTRACTOR <br />�pg/.a.SU.v I�LMb. /�vC <br />NHONE (3b� ) �fo 3' 7�F6 L <br />PFOPOSEO USt OF BUILDING <br />S F,Q <br />PARCEL TAX I.D. M <br />ICONTACTNAME <br />AODRESS <br />6 <br />i933� �iJ•�` .iv� �E <br />�IQ � i...4 Iv.. � w �1 <br />PERMIT <br />TYPE <br />CONTRACT PRICE OF WORK # 1�p <br />PERMIT M <br />. �_ n/ <br />[iv <br />ZIP PHONE <br />PHONE <br />LP CONTR. UCENSE N <br />9Y12; �O$�rP+G27LCZ <br />�Building Mechanical Addition HEAT SOURCE <br />Combinalion R�.�( Plumbing WORK Alterellon [� Electric <br />Demalition LJ Slgn TYPE aw �.] Ges <br />Spnnkle� Rapair/Maint. �.% O�her <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />inJST�cC Fi¢E SP.2�.c.+[CCdP Sy57L�'�'� /.v n-C-+�i S FIZ <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <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/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF fl%TURE OR REM <br />A/C — AIHANDLING �JNITS <br />FORCED AIF SYS fEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />MFTAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />1� SPRi�+t CC.L� r`fs2S <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS ANO ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE ?ROVISION OF ANY OTHEii <br />STATE OR LOCAL LAW REGUU�TING CONSTRUCTION OR THE PERFOi7MANCE OF CONSTRUCTION. THAT � AM .4UTNORIZED BY THE <br />OWNEF OF THIS PROPERN TO PERFORM TNE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH T�aF STATE <br />CONTRACTORS LAW O.j, 27 RC�N AND 296200 WAC. <br />'��i�-S- �I�i�-l� 4��a/v i <br />SignaWre ol OwnedCoNractodAuthoraed Agent Date �(a <br />