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P�RMIT APPLICATI��V <br />CiTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-25'-8�10 — FAX 425-257-&857 <br />SITE ADDRESS <br />9�s9 -���,r�� �' <br />LOT NO.� � BLOCK <br />i <br />I PARCELTAXI.D.k/F�Qn�� <br />;Z.�oS/8�3c�aac� <br />TRACT <br />%��C�2�z-62�- °� <br />f-1,c,�-.,�. �,�a:�. `��u �� ���� �Sui9 <br />ui <br />TENANT NAME <br />ICONTACTNAME <br />PU) �oc.(- �v <br />PERMIT A <br />�"�Z� -O� a <br />PHONE <br />6��/9-7�� 3 <br />PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />�..�.E/Z.b�e�,.�snL.:c.n�r��rvc -�i3vu�����-%9 ��.�s-2cy,�o9AG <br />8/9-��� 3 <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />PEF'..71T � Combinalion Plumbing <br />7YPE Demolitian Sign <br />Sprinkler <br />{�'0�,�` <br />�Additian I HEATSOURCE <br />Alleration � Electric <br />NeW Gas <br />RepaidMaint Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION / , /� � <br />�✓�r,J (�vGo� C.otiis;ru�cn� d/.v4c.�' -�iFa-r.c.y <br />-� a s, � ���a,J -yv3 � <br />— PL�M` <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATERCLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />UAINAI <br />DRINKING FOUNTA'N <br />FLOOR DRAIN <br />BACKFLOW PREVENTEH <br />SINK (SERVICE/BAR/MOP,E i (' ) <br />OTHER <br />NO. I TYPE OF FIXTURE OR REM <br />A/C — AlHANDLING UNITS <br />Z FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />/ CLOTHES DRYER <br />� RANGEHOOD <br />T WATER HEATER <br />� METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />!- GAS FIREPLACE <br />� GAS RANGE <br />� GAS PIPING <br />3 EXHAU :T FAN <br />OTHER <br />L/Si n/GJ <br />i <br />5 <br />I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br />PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEFEIN OR <br />NOT. THE GAANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEA <br />STATE OR LOCAL LAW REGULATING COIJSTHUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PR PERTY TO PERFORM TH.� ':VORK FOR WHICH APPLICATION IS MAGE AND I COMPLY WITH THE STATE <br />CONTRACTORSLA�j1� ��ANf�S,B��� <br />� (� �-Z�-GL <br />