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PERMIT APPLICATId1V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-0810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. k <br />��� �� S-�,',�-�-,, -��^�-W-td Cr 0 S� b l�l o �_ �� ��� l <br />LEGA LOTNO. BLOCK TRACT <br />DESC. /� <br />OWNER ADDRESS <br />li�li�J�-5 �h,���'C 3071�-3�� � N�✓ S� <br />TENANT AME I CONTACTNAME <br />ADORESS _ � --- <br />e-�-�� � a v 7 r �- 3 c, �<<-�.,o r�. 4�. <br />�m�� mS f- �.so <br />PROPOSED USE OF BUILDING <br />$./-. /1� <br />CONTRACT PRICE OF WORK <br />1' �(� 1:1:7 �] �YN:I I 1 l[�l : l <br />NO. <br />� <br />TVPE OF FIXTURE OR ITEM <br />jJ( Building jjj��� Mechanical <br />PERMi7 �} Comhination j�P�umbing <br />TYPE D Demoiition � Sign <br />L� Sprinkler <br />,(� <br />J ��—i� <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/8AR/MOP/ETC.) <br />OTHER <br />ZIP <br />y��9L <br />TYPE <br />PERMIT q <br />Co �Qa-oa <br />�HONE <br />9L 36c�GS�-13a� <br />PIiONE <br />3�e -Gsa-�3�9 <br />CONTR. LICENSE M <br />�NlpHsco,sf �� <br />Addition I HEATSOURCE <br />Alterntion Electric <br />New �Gas <br />Repair/Maint. Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />!��"� �•l�- �-- i /.� <br />NO. � TYPE OF FIXTURE OR ITEM <br />_ A/C—A/HANDLINGUNITS <br />_L FORCED AIR SYSTEMS <br />_ HEATPUMP <br />tIN1T HEATERS <br />T CLOTHES DRYER <br />� RANGEHOOD <br />� WATER HEATER <br />TAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />�. GAS FIREPLACE <br />GAS RANGE <br />�GAS PIPING <br />EXHAUST FAN <br />_ OTHER� <br />1 HEREBY CERITIFY THAT 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 TYPE OF WORK WILL DE COMPUEO WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PqESUME TO GIVE AUTHOR:TY TO VIOLATE 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 PROPERL�' TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT�TORS 4AW 18.�Zi�HCW �,ND 296,R00 WAC. <br />,�-/— o <br />�� 3iaS.� <br />