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�CRMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR £iTRFF_T, EVERETT, WA 98201 <br />425-257 �8810 - FAX 425-257-8857 <br />SITE ADDFtESS <br />i"L��/,2���/1��, w. <br />LEGA LOT NO. BLUCK I TRACT <br />DESC. 7 I <br />�-c� e� � �.le_ // <br />TENANTNAME <br />S�-�e, <br />CONTRACTOR s'�q � <br />PHONE <br />PROPOS'cD USE OF BUILDING <br />S C'l �� <br />S��J�iLE F{kMux 126sib6 <br />CONTRACT PRICE OF WORK <br />PARCEL TAX I.D. # aERrniT a <br />`3 f3 —�c: cc:�.S c� —a� �� Ca3 � <br />/ .� (� 5- 'DU F� - U z <br />3 .'to9 -���1 ��• <br />�/ (/VV • Jf�lC � <br />I CONTACT NAU7E <br />-S c._� r/ ��,�-r <br />ADORESS <br />� ��, <br />ZIP <br />-o <br />y�S__ <br />� �3 Z-6 z <br />PHONE <br />�.5�.�9*ti � <br />CONTR. IICENSE N <br />Lv�v,peSD eyyf—�.rL <br />E3uilding D Mechanical Atldition HEATSOURCE <br />PERMIT � Combina�ion U Plumbing WORK � Alleralion � Electric <br />TYPE Demolition U Sign TYPE New Gas <br />Sprinklet Repair/MainL Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />WORK DESCRIPTION <br />.%��9.5! �- /�' � "z2 %z <br />NO. I TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET <br />? BATHTUB <br />�LAVATOFY (WASH BAS�N) <br />SHOWER <br />/ KITCHEN SINK 8 DISPOSAL <br />�- DISHWASHER <br />IAUNDRYTRAY <br />� CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (ScRVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />Z FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />UNIT HEATERS <br />�CLOTHES DRYER <br />RANGE HOOC <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLkCE INSERT <br />-7 GAS FIREPLACE <br />GAS RANGE <br />.3 GAS PIPING <br />� EXHAUSTFAN <br />OTHER <br />I HEAEBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COP.RECT. ALL <br />PROVISIONS OF LAWS AN� ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH 1VHETHER SPECIFIED HEPEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLr'.TE OR CANCcL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZF.D BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THI= VJORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 VJAC. <br />