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,. ._ <br />P�.r�MIT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />q-a7-aZ <br />SITE ADDRESS PARCEL TAX I.D. # P RMIT a <br />��i_s .s t�.�.'s �= r �9�vc— 2`1n�-��,�-x�� 4vG� 4c� � �.9 �`7 ' D/ � <br />LOT NO. � BLOCK I TRACT <br />DESC <br />jl��� 1>. <br />TENANTNAME <br />CONTRACTOR <br />CCC`>Z✓1-9 /�.4I7c,L P[ tL.S <br />PHONE /!7`_J �)/ � �,� <br />�� <br />PROPOSED USE OF BUILDING <br />✓//li i�LC= f�r�� cJ/C � /-'� S <br />`� rT (iJ�., � ��L'; ySzC'� 2'� Z - <br />CONTACTNAME / PHONE <br />!'-�!%i✓ � �=//.�'-1SMfY✓ ( �J-�5� 1 � / � l7� <br />ADDRESS ZIP CONTR. LICENSE M <br />��(.��f `��/7 >y; A7�(p'iLTtU `�"275 QC(SiUMF- <br />Building Mechanical <br />PERMIT ombinalion Plumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />Adtlition HEATSOURCE <br />WORK Alleralion � Electric <br />IYPE New Gas <br />Repair/Ideint. Other <br />CONTRACT PRICE OF WORK �Jil`i �� I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK OESCRIPTION <br />,r�--,�i� 2-iiri3:'c�r�.v// ��,� f�riTN /li,U�/%/�'�V i L /�C—/9/- C�/= GC'/ST />c-S <br />yz3'� � <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />6ATHfU� <br />LA�ATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISPOSAL <br />DISfiWASI1ER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEH <br />SINK (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEFS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS FANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER_ <br />I HERE9Y Cf RITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICAT;ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONb OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPIIED WITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A P(AMIT DOES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE P(;OVISION OF ANY OTHER <br />STATE OF IOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER QF THIS PROPEFiI' TO PERFORM THE WORK FOR WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br />CONTRdCTORS L..1VJ iH.27 RCIV AND 29G200 WAC. <br />. i l�;�C % ��i'=,� roi-Lc��sfc `i"`///�(iZ� <br />5ignaWre oi u� er,�c� ctont+u�nonzea ngern ua�e � <br />� h <br />