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� <br />� <br />SIT A DRESS <br />`�%Z C � <br />� <br />LEGA LOT NO. <br />TENANT NAME <br />C���a � � � � <br />CONTRACTOR /'en�s <br />L� <br />P��RMIT APPLICA'�I�,N <br />CITY OF EVERETT pERMIT SERVICES <br />3200 CEDAR STREET, EVERcTT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. k <br />BLOCK TRACT <br />ADDRESS <br />�. � I'QNTACT NAME <br />��el I �ev�e� 1a��ne� <br />� �� �g ADDRESS IO�CI(6 0 �d, m ��JN� <br />PHONE �i�O `�6� _$,`� <br />.� J <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYPE OF flXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCNEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />� <br />Building jjj��� Mechanical <br />PEflMIT R Combination �} Plumbing <br />TYPE Demolilion � Sign <br />Sprinkler <br />PERMIT k <br />X �a�� -�� <br />L/Z� ZSz-�Igg <br />PHONE <br />3Gd -g�3-�s� <br />ZIP CONTR. LICENSE N <br />q�27z <br />Adtlilion <br />WORK Alteration <br />TYPE New�'� <br />Ropair/Maint. <br />HEATSOURCE <br />E�ectric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />NO. I TYPE OF FlXTURE OR ITF.M <br />A/C — A/HANDLING UNITS <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />UNIT HEATEflS <br />� CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATEfi <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSEFT <br />_ GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />_ EXHAUST FAN <br />OTHER <br />I HEFEBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflECT. ALL <br />PqOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WI'iH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OA THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS P PEflTY TO PEPFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA� ORS 78.27 RCW AND 296200 W:+C. <br />%.,. ,.�«%� �o-//-oz <br />