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P�RMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />/COC3 - 2/Q.� �c�,e, t�c.� 425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS �>��"z �" � PARCEL TAX I.D. # � <br />LOT NO. � BLOCK � TRACT <br />DESC. <br />—C�'��-001 —(XSd <br />%?aZ-Z�Z <br />� c�>>`i` /4r�H+�o d � � � /o y •�'L S f �ve.ce.}� «. • �F3 � aE� <br />TENANT NAME CONTACT NAME PHONE <br />I SColt �Zo,�s,4•✓o v2s-a3a-E290 <br />CONTRACTOh I�Q��G/� sculi �Y2��R�T �✓�, ZIP CONTR.LICENSEN <br />CGo � ��pesrJ�Ys-r�,� <br />PHONE _ <br />PROPOSED USE OF BUILDING <br />S�I/ �S�e,c. /�o�-,.c <br />CONTRACT ('910E OF WORK <br />WORK �ESCRIPTION <br />//`�-� <br />- t�.�. %O � �Fr�+ � .sLS �9-b� <br />Building DAlechanical <br />P[RMIT � Cpmbination I ) Plumbing <br />TYPE IJemolition � Sign <br />Sprinkler <br />� �v �(�--� <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET � � � <br />BATHTUB I <br />LAVATORY (WASH BASIIJ) +/ / <br />SHOWER li <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHER <br />Addition HEATSOUflCE <br />WORK � Alteiallon � Electdc <br />TYPE Nnw Ges <br />. Repa'v/Mainl. Other <br />— ! CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />NO. � TYPE OF FIXTURE OR REM <br />A/G – A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHEE DRYER <br />RANGEHJOD <br />WAT R <br />iE AL FIREPLA STOVE <br />EPLA RT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN ///� <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATlON AND KNOW THE SAME 1�0 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1VPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEG HEREIN OR <br />NOT. THE GRANTING OF A PENMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR Ll1CAL LAW REGULATING CONSTRUCTION OR T�1E PERFORMANCE OP i.UNSTRUCTION. THAT I AM11 AUTHORIZED BY THE <br />OWNER OF THI� PROPERTY TO PERFORM THE WORK FOR �VHICH APPLICATIQM IS MAUE ANC� I COM,PLY Wli:i THF STATE <br />CONTRACTORS LAW 1827 FCW AND 296200 WAC. <br />3 <br />/a <br />