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`1 � <br />SITE ADDRESS <br />LEGA LOT NO.� <br />CESG �1 <br />I�LRMIT APPLICATI�N <br />C►,7Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />b5 t5c �Un�,-ooa- <br />� ���� �, �� <br />PERMIT k <br />'a�i��� -o/o <br />�ic�cci2 L1��Rxses l�to3a• 3s�A�eSF t�r#rtell �6�a �FaS'lQ3�111$ <br />TENANTNA4IE I CONTACTNAME PHONE <br />CONTRACTOR • ADORES� <br />(�d2c«g--��i1�l�se��1,-hC �-�o3a-3S�'�I,seS� <br />PHONE ���_ <br />PROPOSED USE OF BUIL�ING <br />.51(�S�¢.'o. _ '_— \ <br />.Jtc.1U�1=� <br />CONTRACT PRICE OF WORK <br />�i Building [� Mechanical <br />PERMIT �JfComhinalion �Plumbing <br />TYPE D Demolilion Sign <br />D Sprinkler <br />ZIP CONTR. LICENSE M <br />`l�o�a- AD43iQE�az,��.� <br />�ddition <br />Alleralion <br />ew <br />Fepair/Maint. <br />HEATSOURCE <br />�lectric <br />as <br />Olher <br />CITY OF EVEREIT LOCAL SALES TAX COOE IS 3105 <br />WORKDESCRIPTION C� � n1 ��rn � �\ �� � ' ��p"�� ' `� � ' <br />�W.Tt �yb U v \ .n9-�L� <br />NO. I TYAE OF FIXTURE OR REM <br />� WATER CLOSET <br />� BATHTUB <br />� LAVATOFlY (WASH BASIN) <br />SHOWER <br />� Y.ITCHEN SINK & DISPOSAL <br />� DISHWASHER <br />LAUNOFY TRAY' <br />� CLOTHES WASHER <br />URINAL <br />DFiINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. � TYPE OF FlXTURE OR REM <br />A!C –A/HANDLING UNITS <br />= FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />�_ CLOTHES DRYER <br />l RANGEHOOD <br />� WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />I GAS FIREPLACE <br />� GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />_ OTHER <br />I HEREBV CERITIFY ?HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUPAE TO GIVE AUTHOR�TY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR LOCAL W W REGUTATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEflTY TO PEPFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />b a- <br />IL <br />