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P�RMIT APPLICATII��V <br />CITY OF EVERETY� PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8870 — FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # <br />� �ia �.a'`� sf �a�t3�l ��f��o3ooi <br />LEGA LOTNO. j� 3I�4 <br />oesc. �y0f# Go�, <br />OWNER <br />��e �V�A � <br />TENANTNAME <br />BLOCK TRACT <br />f �� n-oi <br />CONTACTNAME <br />�Sf SF. °1��d <br />PERMIT s <br />�a�rd-r�-� <br />PHONE <br />�voNe� I��C� BiN�ON yas ayy-ayo�. <br />CONTRACTOfl ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />PERMIT � Combination Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />Addi�ion <br />Alteration <br />New <br />Repair/Mainl. <br />HEATSOURCE <br />Electric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WOR DESFRIPTION �e.S�-'pII GGS P�p�N9 rOR ��ReGf� V!�✓`f F�Rt�IpC[ fi"QS NrA?f�El�laf[f� <br />qN� P��e �orc F�+�rM�z �as R��gc a,vc( 2�sY�a 1/ F�Rr�1A�c a��( c�k7�� Idcar��' <br />N0. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAPJMOP/ TC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />A/C — A/HANDL�NG UNITS <br />FOR(;ED AIR SYSTEMS <br />HEA'f PUMP <br />UNIT HEATERS <br />CLCTHES DRYER <br />RANGEHOOD <br />WATER HEATEP. <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY'HAT I HAVE F±EAD AND EXA�,IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIM OR <br />NOT. THE GRANTING OF A PERIdIT DOES NOT F: �ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEFi <br />STATE Oii LOCAL LAW FEGULATING CONSTRUCTi �N OR THE PERFORMANCE OF CONSTRUCTIOIJ. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS PFOPERTY TO PERFOFM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />/ <br />