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PERMIT APPLICATIQN <br />CITY OF EVERETT PERIUIIT SEf�VICES <br />3200 CEDAR STREET, EVE�iEl7, WA 98201 <br />425-257-8810 — FAX 425-257-8957 <br />SITE ADDRESS <br />7y��,- �7 � v2. ��. � vr <br />LEGA LOTNO. BLOCK <br />� 69 !'1.l�i � `'� <br />TENANT NAME <br />r-- <br />PARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />�O�% � % �` 7i�. %� <br />CONTACTNAME <br />CONTRACTOR �N�� � /iG.�y ��� ADDRESS �Q ���, �S� 21P <br />�� �' <br />PHONE . ���0� -,�O'�� �TNGr <br />y�s 39 �J-3 s�f " <br />PROP(7SED USE OF BUILDI�JG <br />PERMIT <br />� TYPE <br />CONTRACT PRICE OF WONK ��,�1<i <br />v <br />WORK DESCRIPTION <br />NO. <br />,�-��q ��e <br />2,(�/S�i�?/� <br />BING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BNTHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SI�K & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />�A-Kc�" ST� <br />�Building n Mechanical <br />Combination �' S Plumbing <br />Demolition � Sign <br />Sprinkler (# of heads) <br />PERMIT k <br />rno3 � <br />Y�s 3 <br />PHONE <br />'aS 3 ��-o,�� �f <br />CONTR. LICENSE p <br />�N�TRG � � G3'�7 .� <br />�Addition I HEAT SOURCE <br />Alteratinn ,�Electric <br />New � Ges <br />RepairfMainL O�her <br />CITY OF EVEREff LOCAL SALES TAX CODE IS 3105 <br />D � r <br />�r-�ci=Y� c G��a � v Li.e9�2�' <br />l <br />NO, I TYPE OF FIY,TURE OR ITEM <br />_� AIC—A/HANDLING UNITS <br />FORCFD AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEA7ERS <br />CLOTHES DRYER <br />RANGE HOOD <br />� WATER HEA7ER <br />ME1 AL FIREPiACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />CAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBY CERITIFY THAT I HAVE REA� �AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8'c TRUE AND CGRflECT. ALL <br />PROVISIONS OF LAWS �.ND ORIDINACES GOVERNING THIS TYPE OF 1NORK WILL BE COMPLIED WITN WH�HER FPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CO 3TRUCTION OR THE PERFOFiMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERF M THE WORK FOR WHIGH APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br />CONTRAQ30RS LX�W 1827.4i�W_pND ?6.7,�')fl WAC. <br />� <br />