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F�.�RMIT APPLICATI� N <br />CIl'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />O LLL- 3��3�rc�� <br />LEGA � . LOT N� <br />DESC. <br />OWNER <br />� �—i-l� �u —�—� i <br />TENANTNAME <br />CONTRACTOp <br />v�.yt..�PLC In.t�K ��, <br />PHOKE <br />C�r�s)�5�- ��I/ <br />PROPOSEO USE OF BUILDING <br />SIC� <br />CON7RAC7 PRICE OF WORK � <br />WORK DESCRIPTION <br />PARCEL TAX I.D. N <br />�, E W � <br />BLOCK TRqCT <br />AODRESS <br />` �a/f3 -33r.� • � <br />� CONTACTNAME <br />ADORESS <br />2l� 18 -G� t" �e- lJ� #av7 <br />w�a.,�,�1-to.ic�-l-eu;ro.e� wt�.y4�uy3 <br />PERMIT <br />TYPE <br />Building Mechanical <br />Combinalion Plumbing <br />Demolidon �Sign <br />Sprinkler <br />� us p, �.e �...��� c.,r I,�.e�,�-e�t`-, s <br />NO. I TYPE OF flXTURE OR REM <br />wq i tH GLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TFiAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTP,I�! <br />FLOOR DRAIN <br />BACKFLOW PRF.VENTER <br />SINK (SERVICFJBAR/MOP/I_TC.) <br />OTHER___ _ <br />PERMIT p <br />M o � i G-�3 �( <br />PMONE <br />LP COMR. LICENSE M <br />O 1.Y ►� Pkt�L t7ov / <br />-- �� P' °3!°-tff? a � <br />o' <br />(7 AddiHon HEAT SOURCE <br />F_� Alteralion �] Electric <br />4_� Naw U Gas <br />U Repair/Maint. �J Other <br />CRY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�� �K vj'� ��q� <br />NO• I TYPE OF fIXTURE OR REM <br />A/C — AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAI FIREPLACEJSTOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CEi�ITIFY THAT I HAVE RE4D ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONu OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER O THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON7R TO W 18.27 CW N 296.200 WAC. <br />alure of wner onlractor Authonzed Agent /� �r ate <br />