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P� �MIT APPLICATIC 1 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 5TREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS elE11f-%l W), FpRCEL TAX I.D. p I PERI,IIT p 4 <br />x o'733 aa`�rr_ �� �a�z��l � a c��-o G <br />I_EGA LOT N0. EIOCK TRACT <br />DESC. <br />OWNER AOORESS ZIP PFiONE <br />< �l�,b��-i �r�n� /7�'33 � �.u� titE�s6A q��s`��• �6•y�o-�/�3 <br />TENANTNAME I CONTACTNAME PHONE <br />1INIU�C/=/lCf C�/M�,dL,'J/l''l <br />CONTRACTOR <br />PHONE GI/ <br />� �' � <br />PROPOSED USE OF BIiILDIYG <br />��U L 1 ���(1L`( L`FOR E <br />CONTHACT PRICE OF WORK <br />ADDRESS <br />Building Mechanical <br />PERMiT Combination B Plumbing <br />7YPE Demolition U Sign <br />Sprinkler <br />WORK DESCRIPTION <br />�SNS 'P�t�.p 1 Arsr�. <br />NO. I TYPE OF FIXTURE OR ITEM <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 />OACKFL��W PREVENTER <br />SINK (SErIVICE/BAR/MOP/ETC.) <br />OTHER <br />ZIP CONTR. LICENSE N <br />Addilion <br />Alteration <br />New <br />Ropair/Meint. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />AlC: — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UWIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION AND KNOW THE SAME ". 0 BE TRUE AND CORRECT. ALL <br />Pi;OVISI0N5 OF LAWS AN� ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREItJ OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUA7E TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PAOVISION OF ANl' OTHER <br />STATE OR LOCAL Ll+W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIUN. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFiK FOR WiiICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC70F5 LAW 1827 RCW AND 296.200 WAC. <br />�—,l1'`0, a�-..�G� L'��,,.,G�., L�' k� ti G�a 7%z�v �, <br />