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C `ERMIT APPLICAI�.�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 />i'-� I 1 .�ti` �� � <br />LEGA LOT N0. <br />oesc. � y Z <br />OWNEq <br />t'-i I I Sd'"'" � s�� <br />TENANTNAME <br />�ro+�-� �"�au SS � <br />CONTRACTOH 0��,,.�I <br />PHONE �� �w <br />.ai.itiw..•s77- <br />PROPOSED USE OF P.UILDING <br />S�i�-- <br />BLOCK <br />PARCEL TAX I.D. M <br />c.�1�-� W�F ` <br />I CONTACTNAME <br />��t/ SSc <br />ADDRESS <br />Buiiding Mechanical <br />PERMIT � Combination R Plumbing <br />TYPE Demolition p Sign <br />Sprinkler <br />CONTRACT PHICE OF WORK 4-�p p,» <br />WORK DESCHIPTION <br />/ � x 3'�- +lari � A�� �-r��r�l <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />,�, DISHWASHER <br />LAUNDRY TRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKfLOW PREVENTER <br />_ SINK (SERVICEJBAF/MOP/ETC.) <br />_� OTHER <br />PERMIT M <br />GOa.II'OL <br />)25`� -03 = <br />PHONE <br />}�l5vv�"�' �2 <br />Z�P CONTR. LICENSE N <br />Addition HEAT SOURCE <br />Alteration � Electric <br />New Gas <br />Repair/Maint. Other <br />-- � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />N0. I TYPE OF FlIfTURE OR ITEM <br />_ A/C -A/HANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DFIYER <br />�RANGEHOOD <br />WATER HEATER <br />_ METAI FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS FANGE <br />GAS PIPING <br />� EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GUVERNING THIS TYPE OF WOPK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OP 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 APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRy�CTOFS LAW 18.27 RCW AND 296.200 WAC. . <br />N <br />►1/'3J <br />