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r. <br />APPLiCATION <br />CITY OF EVERETT PERiVIIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />� �g� ST <br />LEGA LOT N0. <br />DESC. <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />=3QR3.�C�1 <br />�°�//'G/% <br />PERMIT # <br />CNI-'ISTvPI-IE� OI�S�N z.q-I� I�� sT. �i�ZG'I A-Zs zsz 50�7 <br />TENANTNAME I CONTACTNAME PHONE <br />// / � /i // <br />CONTRACTOR <br />�� <br />PHONE <br />PROPOSED USE OF BUILDING <br />�/ <br />PERMIT <br />TYPE <br />ADDRESS <br />�� /� <br />Building Mechanical <br />Combination � Plumbing WORK <br />Demolition Sign 7vPe <br />Sprinkler <br />ZIP CONTR. LICENSE q <br />Addition I HEAT SOURCE <br />Alleration Electric <br />New �Gas <br />Repair/Maint Otner <br />CONTRAC7 PRICE OF WORK�/� /io CITY OF EVEREfT LOCAL SALES TA% CODE IS 3105 <br />(, L� <br />WORKDESCRIPTION ��! ,�vPUei bC%{/1/�/ ll�{(�V� �l(�7 �G�i�"Sl"���� Sl+�O[,y�� <br />N1CVE �f��TIT/ON G���LC.S <br />NO. I TYPE OF FIXTURE OR ITEM <br />y� <br />WATER CLOSET <br />9ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SCRVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEATPUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />FANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />� EXHAUST FAN <br />OTHER <br />I HEAEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATIGN AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WI:.L BE COMPLIED WITH 6YHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh71T DOES.�{OT PRESUh1E TO GIVE AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUIFtTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEq�OR�vI THE WORK FOF WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOHS LAW 1827 RCLV AND 29fi200 WAC. � <br />/ <br />' �Gl� �� %,�.:� � �� l� /l��Z�; Gi <br />Si aWre ot wnedContraclodAuthorized Agenl , Dale 1/a <br />/ <br />