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i <br />�I <br />� <br />PE�.M1T APPLICATI�� , <br />CITY OF E'JFRETT PEHMIT S�RVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />A25-257-881 G - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # PE�RMIT � <br />� � � �- �:�=� . . � '„ , , ' : _ : ' .. , � -o�_ <br />. , .;" �, ,; <br />LEGAL LOTNO. BLOCK TRACT � � , ,. .��'�.( r�;l•.'-' � - ����, ; <br />�ESC. . . , ��' " <br />, . �., _ �i!.., .:�... 7``f/i L%.� .— <br />TENANT NAME <br />CONTRACTOR -. , <br />� '� ��� . .. . . .. .. <br />PHONE <br />� <br />`t.1/') r'/� <br />��� <br />PROPOSED USE OF BUILDING I <br />PERh11T <br />TYPE <br />CONTRACT PFICE OF WORK <br />WOFiK DESCRIPTION <br />����,� �1 <br />. . . � ' �.�'l /. <br />CONiACTNAMF. PHONE <br />. � , �,'\s=—J ,' �'ic:� , /1 ��^_.� �'7/ � G-:.', �G :. - . . . ..' <br />AODRESS <br />�Building n Mechanical <br />Combisalion I"j Plumbing <br />Demolition b Sign <br />Sprinkler <br />jP�u-�. �.n <br />NO. I TYPE OF FIXTURE OR ITEM <br />WA7EA GLOSET <br />BATHTUB <br />LAVATORY�(WASH BASIN) - <br />SHOWE� <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTFIES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />_ SINK (SERVICEiBAR/MOPlETC.) <br />ZIP CONTF. LICENSE d <br />Addition <br />WORK -Alteration <br />TYPE �Jew <br />FepaiVldaint. <br />NEATSOURCE <br />� Eleciric <br />Gas <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I� U/ OJ ' O �� �-�t �/ �' �'- <br />i <br />��-Lrz• 'u �� �Z) S P��� '1T • <br />N0. I TYPE OF FIXTURE OR ITGM <br />'� A/C-A/HANDLING UNITS <br />FOACED AIR SYSTEMS <br />HE.4T PUMP <br />UNIT IIEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE;STOVE <br />FIFE?LACE INSEP.T <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN ; � <br />OTHER ' <br />oL -fc � <br />I HEFEBY CERiTIfY'HAT I HAVE READ AND EXAPdINED THIS APPLICATION AfJD KNOW THE SdIdE TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS CF L1WS AND ORIDINACES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED WITH WH�HEP. SPECIFIED HEREIN OH <br />NOT. THE Gf1AWTING OF A PER�dl7 DOES NqT PRESUh1E TO GIVE AUTHORIN TO VIOWTE OR C.4NCEL THE PROVISION GF ANY OTHER <br />STATe OR LOCAL LAW REGULATING CONSTFUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TF'E INORK r"OR VJHIGH APPLICATION IS hiAC�E AND I COh1PLY WITH THE STATE <br />COMTFACTORS W�V 1827 RC'N AND 296200'NAC. <br />)vrnedContractor/Authorized AceN Date / <br />/�//�l�C1V�/�b� ri%?L%t'/"!'Y'�(i% ��L <br />