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PE,�MIT APPLICATIO'� <br />CITY Oi- EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FA:C 425-257-8857 <br />SITE ADDRESS <br />qql2-Z.��` /�ve <br />�0��10• I BLOCK <br />� <br />PARCEL TAX I.D. / <br />2805 �bD3- lU� <br />THACT <br />�2oZ-3o-az <br />���� ��C��-G��i <br />�e�ac�Nflrnes Nw InC. i"sies'��S�eJens Rd.ttzao Z'P PHONE y�, <br />U2 S.,p , r��, wA 9s2s5C 33y-os�,3 <br />�TENANTNAME I CONTACTNAME <br />PHONE <br />EI j 11 �--I I( CJQI�'�J� l�1 <br />CONTRACTOR LeC�GC`� <br />J <br />PHONE <br />PROPOSED'JSE OF BUILDING <br />5�2 - <br />^.ONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />sF'2 <br />PERMIT <br />TYPE <br />(.+ , AODRESS � g;� J^ , L�, ; <br />�Zd�t 2.a� <br />LYt S�evenS�t�/<f <br />�Building n Mechanical <br />Combinalion r} plumbing <br />�emolition p Sign <br />Sprinkler <br />i��a r� � ��O <br />'�3as'�c� Zz2� <br />NO. � TYPE OF FIXTURE OR ITEM <br />� <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DIS„WASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />D'iINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SIIJK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />ZIP CONTR. LICENSE N <br />L6C-��4C/1n1044R.k <br />�Addilion I HEATSOURCE <br />Alteration Electric <br />New Gas <br />Repair/Maint Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />NO. � TYPE OF FIXTURE OR REM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIFEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS �IREPLACE <br />GAS FANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHEF <br />1 HEREBY CERITIFY THAT I HAVE (iEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROV!SIONS OF LAWS AND OaIDINACES GOVERNING THIS TYPE CF WOFK WILL BF COMPl1ED WITH WHETHER SPECIFIED HEFEIN OR <br />NOT. THE GPANTING OF A PERMIT DOES NOT PRESUME TO GI4E AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAI LAW REGULSTING 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 />CONTRACTOqS LAW 18.27 flCW AND 296.200 WAC. <br />Signalure of Owner/Contractor/Authorized Agent Dale ]/� <br />( <br />