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I � �RIVIIT APPLICAT: )N <br />' GITY OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVER[TT, WA 98201 <br />425-257-8810 - FAX 4?_5-257-8857 <br />SITE ADDRESS <br />�S/c� - i'� <br />LEGA LOT NO. <br />��_ s � <br />BLOCK TRACT <br />`�}�L 1-F�2 �� <br />TENANT NAh1E <br />S�tit�_ <br />PAHCF:L TAX I.D. # <br />ssc� •-9 �- <br />ICONTACTNAME <br />CONTflACTOR <br />N u" �, "�,C 6-`J � L�R u�-i`�. ��r�.t. <br />PHONE <br />�1S -S��F-� l l l <br />PROPOSED USE OF BUILDING I <br />s r (� . <br />PERMIT <br />TYPE <br />Sf <br />ADDRESS <br />r��.n 1+�9 Q���� <br />�Building � Mechanical <br />Combination Plumbing <br />Demolition Sign <br />Sprinkler <br />CDNTRACT PFiICE OF WORK ?) �' g�L `� " <br />/ �` <br />PERMIT # <br />mczil-c3c� <br />��Eh ��2�.3 <br />Pl10NE <br />ZIP pOf�TR. LICENSE N <br />id' ��� 1�t6LENEsL 9 4 9lV' �-1 <br />Addition I HEATSOURCE <br />WORK Alleration Electric <br />IYPE New �Gas <br />fiepair/�daint. U Other <br />CITY OF EVERETT LOCAL SALES TA% COOE IS 3105 <br />YY V Flf� UCJpHIY I I V fV <br />3- N S Nt� L CrF1 S iN S� 1 `� �'i �.Lf Ir <br />Ca <br />N0� I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ DATNTUB <br />1..4VATORY (WASH BASIN) <br />_i SHOWER <br />KITCHEN SINK & DISPOSAL <br />UISHWASHER <br />LAUfJDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOVYPREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTF:FR <br />N0. I TVpE OF FIXTURE OR ITEM <br />_I /VG — A/HANDLING UNIT; <br />_ FORCED AIR SYSTEMS <br />_ HEAT PUMP <br />UNIT HEATERS <br />_L CLOTHES DRYER <br />RANGE HOOD <br />� WATER f+EP i ER <br />� METAL FII;EPLACE/STOVE <br />� FIREPLl�.�E iNSERT <br />_ C4S P:riEPLACE <br />/ GAS RANGE <br />GA,S PIPING <br />_ �kHAUST FP,N <br />_., OTHER_ <br />I HEFE6Y CERITIFY THAT I HAVE READ AND EXAtdiNED THIS APPLICP: fION ANO KNOW THE SAME TO BE TRUE AND CORRECT. A�L <br />PRpVISIONS OF L16VS AND ORIDINACES GUVERNiNG THIS TYPE Of� WORK WILL BE COMPLIED WITN WHE7HER SPECIFIED HEREIN OR <br />NOT. 7HE GRANTING OF A PERMIT �OES NOT PRE:SUIdE TO GIVF ACTHOFITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OP LOCAL lAW REGULATING CONSTRUCTION OR THE PcRFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEP JF THIS PROPEP.TY TO PEPFORM THE WORK FOR Vd>iICN APPLICATION IS hiADE AND I COMPLY WITH THE STATE <br />CONT�ACTORS LAW 18.27 RCW AND 296200 WAC. <br />, <br />