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'� F�ERMIT APPLIG/�TION <br />� CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE AODRESS <br />�� a� � �7�" 1 ; u �, � � a <br />LEGAL LOT N0. BLOCK TRACT <br />DESC. : � . <br />1-I � a� (z. � <br />TENANTNAME <br />W.s�s� 4-�-c <br />O TRACTQR <br />� c�a�2C�1,1�, ,�lS�i�U_� <br />PHONE <br />PROPOSED USE OF BU�LDING <br />S � r��\� ���` <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />������`�� ��� <br />PARCEL TAX I.D. � <br />PERMIT # <br />l�0�,2--�v5��u�S� �vcr��9-Q q`6o�a- <br />ICO' TACT FOR PERMIT <br />�..`�J 1��SS� <br />-��13� 11 <br />PHJNE <br />�i 3-J'"t'l 3- l l l$ <br />ADORESS ZIP CONTR. LICENSE # <br />�?o3a -3 ����5� �o�iQq`�o�a- Ia�Ar2r_�o�a� <br />Building echanical <br />PERMIT Ccmbination �lumbing <br />iYPe Dei.ioliti�n Sign <br />Sprinkler <br />Addition <br />WORK Alteration <br />TYPE w <br />RepairlMaint. <br />HEATSUURCE <br />Electnc <br />s <br />Other <br />CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� ��-��y �� <br />P�umeir <br />NO. I TYPE OF FIXI�URE OR ITEN <br />S WATER CLGSET (TOILET) <br />� BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOW ER <br />� KITCHEN SINK 8 DISPOSAL <br />I DISHWASHER <br />LAUNDRYTRAY <br />_L CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />_ OTNER <br />�� �-a., f c � �{ <br />NO. � TYPE OF FIXTURE OR ITEM <br />.H/l:—A/HANULING UNITS <br />1 FORCED AIR SYSTFMS <br />HEF�T PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />_ RANGE HOOD Oluteo <br />� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPIACE INSERT <br />� GAS FIREPLACE <br />,� GAS RANGE <br />5 GAS PIPING <br />� EXHAUSTFAN <br />OTHER <br />I HEREBY CERIT!FY THAT I HAVE READ AND EXAMINEU THIS r�PPLICATiON AND KNOW THE SAME TO BE TRUE FND CORRECT. ALL � <br />FROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPe OF WORK 4l'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN CR � <br />NOT. THE� GRANTING OF A PERA1IT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER � <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCc OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1 B27 RC'N AND 296200 WAC. <br />