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� <br />� <br />SITE ADDRESS <br />PE.��MIT APPLICATIQ�d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />� <%//G �=l,y�,�-, w , <br />LEGA LOT NO. BLOCK TRACT <br />D[SG � <br />PARCEL TAX I.D. # <br />- � DorY) S O -OO <br />a <br />� <br />C��L, /.1 �?:L -C?CJ�j 'vo}�'/CL�ii�� <br />OWNEA ADDRESS � yJ� �_�v y�G, S�_, ZIP PNONE <br />��P��/le�.��� --1c'<:�f% L�r-�l, ��c. �Uetce.�w��9ti�s `!�t"�J-3z 6L?p <br />TENANTNAME I CONTACTNAME PHONE <br />S A�r.H (� �<.�, fj�� /Cu-�r h�..�o <br />CONTRACTOR <br />PHONE <br />S/�'�^-t F_ <br />PROPOSED USE OF BUILOING <br />Sc. // <br />CONTRACT PfiICE OF WORK <br />WORK DESCRIPTION <br />ADD£iESS <br />ZIP CONTR. LICENSE M <br />�-c. £��7es9 � 9�i�, �. <br />Building Mechanical Addition I HEA7'SOURCE <br />PERMIT Combinalion Plumbing WORK Altera�ion i F.lectric <br />TYPE Demolifion Sign TYPE New � Gas <br />Sprinkler Repair/Waint. L) Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />,0.9r:c /'/...: fi- .<.7/3 <br />N0. I TYPE OF FIXTURE OR ITEM <br />3 <br />/ <br />WATER CLOSET <br />BATfiTUB <br />LAVATORY (WhSH BASIN) <br />SHOWER <br />KITCHEN SIPJK & DISPOSAL <br />DISHWASHEF; <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DAINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOPlETC.) <br />OTHEA_ <br />� <br />TYPE OF FIXTURE OFi ITEM <br />A/C - A/HANDLIWG t1NITS <br />FORCED AIR SYSTGMS <br />HEAT PUMP <br />UNIT HEATERS <br />C�OTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIR[PLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEFEBY CE(iITIFY THAT I HAVE READ AND EXAMINEC THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COARECT. ALL <br />PROVISIONS OF LAWS 4ND URIDIfIACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE�FItR SPECI�=IED HEREiN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESVME TO GIVE AUTh10RITY TO VIOLATE OR CANCFL THE PROVISION CF ANY OTHER <br />;TATE OR LOCAI LA'N FEGUTATING GONSTRUL'TION OR THE PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED 9Y THE <br />06VNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIOh IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1027 RCW AND 29E.200 WAC. <br />���v23 f�-9 <br />