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P�RMIT APPLICtiTI(�N <br />� CITY OF EVERETT PERMIT SEF�VICES <br />, 2'� <br />3200 CEDAR STREET, EVERFTT, Wq g8201 �2 V� <br />425-257-8810 — FAX 425-257-8857 <br />�� 7 � �' Z��' ^I �,���i� <br />SITE ADDRESS pARCEL TAX I.D. # • PE I7 u <br />/O 70n -� si �V2,w 538�-cx>u-o���-oGn6 I �2� �i�� <br />ESCL LOT N0. BLOCK TRACT �1%/� Q/�J-T�7�iFrtit Fi��/�MS� �G�it< in.Y �, �..�,� <br />nw.i�.. � /��T f/Y�K .OT /.!�clYt<lt�� /.v /�n/ /4 ...�' /�/e:�-,- � Gl � <br />S�o <br />TENANT NAME <br />N/A- <br />CO�ITRACTOR WL��t,��,/I �S�wl7" <br />I1e_ c.e./„�,�u..l� �—.� � . <br />PHONE <br />PROPOSED USE OF BUILDING <br />SF% i / <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. � TYPE OF FIX1'URE OR 17EM <br />wA I tH CLOSET - <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SF{OWER <br />KITCHEN SINK & DISPOSAL <br />DISHNJASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNI"AIN <br />FLOOR DRAIPJ <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PERMIT <br />TYPE <br />CONT,4CTNAME <br />J �� <br />AD�RESS <br />S /tr-+ � �P-t � �i n�- <br />Building <br />Combination <br />Demoiition <br />Spnnkter <br />L�.2 �i -� 31 �i'.L%0 <br />PHONE <br />ZIP CONTR. LICENSE M <br />We�v4�s�fy,�r� � <br />D Mechanical Addition HEA7SOURCE <br />U Plumbing WORK � Alloration � Electric <br />U Sign TYPF New Gas <br />Repair/Mnint. Other <br />I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. � TYpE OF FlXTURE OR REM <br />� <br />n/c% — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CIOTHES 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 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVEFiNING THIS TYPE OF WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br />N07. THE GRANTING OP A PERMIT DOES NOT � RESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHEq <br />�TATE OR LOCAL LAW REGULATING CONSTRUGTION OR THE PEP.FORMANCE 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Z <br />