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SITE ADDRESS <br />�l1/�-(� " <br />LEGA LOT NO. <br />WC <br />TENANTNAME <br />PE�. �MIT APPLICATIO�. <br />CITY OF EVERETf PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />I PARCEL TAX I.D. # <br />�vz . �.v , .s^3 4 — � n u�� �.s—a — o u <br />BLOCK I 7RACT <br />CD� � (%�—�� j <br />ADORESS <br />� t tl7 %U y .�L. J �� <br />. i ia_ — _ . <br />CONTACTNAME <br />�GcJ �°3— � <br />P MIT # <br />�3 'O � <br />PHONE <br />'! LJ^ L3 z -6 2r?� <br />PHONE <br />S/�`? e I -�c o ���Yf,i-✓�i -- <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />y"i�`?P <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />s.yi, e <br />Building Mechanical <br />PERMIT � Combination R Plumbing <br />TYPE Demolitian � Sign <br />Sprinkler <br />wUMK UtSGFIPTION �� J /C �/,?v � / <br />zZ� z <br />NO. I TYPE OF FIXTURE OR ITEM <br />_,£ WATER CLOSET <br />_2 BATHTUB <br />_� LAVATORY (WASH BASIN) <br />( SHOWER <br />� KITCHEN SINK & DI�?OSA� <br />� DISHWASHER <br />LAUNDRY TRAY <br />� CLOTHES WASHER <br />_ UFiINAL <br />_ DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SE.RVICc/BAR/MOP/ETC.) <br />_ OTHER� <br />w �•aeso,�.��-� c. <br />j� Addition t1EAT SOURCE <br />�� Alleratiun Electric <br />Y�` New Gas <br />U Repair/Maint. Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NU. � TYPE OF FIXfURE OR ITEM <br />A/C -A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS ' <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAI. FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERI7IFY'HAT 1 FiAVE READ AND EXAMINED 7HIS APPIICATION AND KNOW THE SAME TO BE TPUE A�1D CORRECT. ALL <br />PROVISIONS OF L.1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEiHEP SPECIFIED HEREIN OR <br />NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY �i O VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br />STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE 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 COMFLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� <br />�%�.,�/�� �l /� <br />Signalure ol OvmedCoNractoriAu�hn��o� n� � Y/ ^L 2 c <br />r <br />