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SITE ADDRE�SS <br />�;! � O � <br />LEGA LOT NO. <br />PERh�IT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />A25-257-8810 - FAX 425-257-8857 <br />BLOC•K I TRACT <br />PARCEL TAX I.D. M <br />�� <br />23. TtvP. 28 �. R`iE W. M. <br />,Qoc.,4,� ��� �P,� � K Gc�2 P o. 6vx 21 MAr�So�, �J,4 �g83 l <br />TENANTNAME � CONTAC7NAME PHONE <br />`k- �LEwt rv� CZ�(o) ss� -- yz�FS' <br />CO� RACTOR ADDRESS ZIP CONTg. LICENSE N <br />/l/o✓�Thf C-I�ST 7J�V- �J�-/� PD. �X 3`% EBa+t+nDS 98ozo No,c�r_DISbA�4 <br />C�'+-S) 7? `� - �i 1 <br />PROPOSED USE OF BUILDING <br />S�' <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATIiTUB <br />LAVATORY (WASH BASIN) <br />SHONIER <br />�KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />Z CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICGBAR/MOP/[TC.) <br />OTHER <br />nBuilding Mechanical <br />PERMIT �( Combina�ion R Plumbing <br />7YPE Demolilion � Sign <br />B-Sprinkler <br />Addition <br />WORK Alteretion <br />TYPE New <br />Repair/Mal�l. <br />HEATSOURCE <br />RE��,�,� <br />Gas <br />CfTY OF EVERETT IOCAL SALE3 TAX CODE IS 3105 <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />1NATER 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 EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF Ll�WS AND ORIDINACES GOVERNING iHIS TYPE OF WORK WILL BE COMPLIEU WITH WHETHER SPECIFIED IiEREIN OR <br />NOT. TH[ GRANTING OF A PEFMIT �OES NOT PRESUME T� GIVE AUTHOflITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH[ PERFORMANCE 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 />Signature ol OwnerlContraclor/Aulhorized Agenl Dale � v <br />