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� `�RIViIT �4PPLICAT ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />_ %/ <br />SITE ADDRESS <br />�� <br />LOT NO. <br />Olc� +fAAC 4 jAX I.D. q <br />�� fS<�(oUU�ULf1U4� <br />_ „J . c,a - a v , <br />BLOCK TRACT <br />r�SUU3 S�` � l�—d2 <br />�rH ��A <br />��e.�C_ Wa��•, � \c.�c <br />1 � l�o�c 3z,-•5 <br />r,�� <br />/,c,�.s oS -U// <br />PERMIT a <br />�'D�o�"-ti%a' � <br />�,. SF,2u 3 y�-35C. ��7b <br />TENANTNAME I CONTACTNAME PHONE <br />_ I \tP�le \_1f�t��t <br />CONTRACTOR 1I 1 ADDR[SS ZIP CONTR. LICENSE p <br />LGV.tIU�c� �iOnneS T�I� �c,, p,,yf 3z�S <br />PHONE yl� .35�a �1�D�`t �. '1��''•YT l.Nh YrS�� L�t�—f�'TOo1,C� <br />PROPOSED USE OF BUILOING <br />�� �� `� S �"�i <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />PERMI? Combination R�( Plumbing <br />TYPE Demolilian u Sign <br />Sprinkler <br />S, c�Uu <br />WORK DESCRIPTION <br />��:,\<< � ��� ��u»� Sr-�� <br />'31-�5�#i 2i1t A <br />°LU <br />NO. I TYPE OF FIXTURE OR ITEPA <br />WATER CLOSET <br />Z BATHTUB <br />�_ LAVATORY (WASH BASIN) <br />_� SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />I DISHWASHER <br />LAUNDRY TRAY <br />I CLOTHES WASHER <br />URINAL <br />DRINKIN(; FOUNTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />Addilion I HEATSOURCE <br />WORK � Atleration � Electrc <br />TYPE New Gas <br />RepaidMaint. Olher <br />CITY OF F_VERETT LOCAL SALES TAX CODE IS 3105 <br />��� 1�5� I� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/G — A/HANDLING UNITS <br />t FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOD <br />1 WATER HEATEH <br />META� FIREPLACE/STOVE <br />FIREPLACE INSEPT <br />� GAS FIREFlACE <br />�_ GAS RANGE <br />� GAS PIPING <br />� EXHAUSTFAN <br />OTHER <br />I HEREBY CERI'IFY'HAT I HAVE FEAD AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAlNS AND ORIDINACES GOVERNItJG THIS TYPE OF WORK WILL BE COMP�IED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 7hIE GRANTIMG Oi= A PERMIT OOES NOT PRESU�dE TO GIVE AUTHORITI' T7 VI041TE OR CANCEL THc PROVISION OF ANY OTHEfl <br />STATE OR LOCAL LAW REGULATING COPlSTRUCTION OR THE PERFORMANCE UF COtJSTRUCTION. THAT I AM1t AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS 6fADE AND I COMPLY WITH THE STATE <br />CONTRAC70FS LAW 18.27 RCW AND 298�200 WA(T' . <br />a7 <br />�z <br />