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P'�RMIT APPLICATII,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEP.ETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE AODRES$ � <br />-. �'� � <br />I.EGA LOT N0. _ <br />DESC. — <br />OWNER <br />TENA T NAM� <br />CONTRACTOR <br />PHONE ��1 A-� !�'-%�J <br />PROPOSEO USE OF BUILOINO <br />I' Y � _�( '�-�-(� l��l'_ <br />� <br />��l.J <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. M <br />:� (c._�ti�I sc�� <br />CONTACTNAME <br />PfFRM1T M <br />� ,�(JJ L- � .�J � <br />PHONE <br />� � �� <br />ADDRESS ZIP CONTR. LICENSE M <br />r / <br />�j( �P/11rc �t. � n'i�iCL�-t, � .C�'f C�C'.. -iz]r (.�1/c•�. <br />(� Building D Mechanical 4dtl�tion NEAT SOURCE <br />PERMIT [� CPmbination U Plumbing IWORK R Alt,o�rnuon I � Electnc <br />TYPE Derholition U Sign TVPE New Gas <br />B S rinkler Re airRdeint Olher <br />CONTRACTPRICEOFWORK �3�`,�� <br />WOHK DESCRIPTION �� (�I �C� �� /�J(j— <br />J� <br />CITV OF EVERETT IOCAL SALES TA% CODE IS 3105 <br />W l�iL /i,��.l LJ'� NYka tt �U Y ��iy ti(� � <br />� c�>� ��� N�? c.c_ �'ca -��� <br />NO. I TVPE OF FIXTURE OR ITEM <br />WATFR CLOSET <br />BATHTUB <br />LAVATOfiY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />UFINAL <br />DFINKING FOUNTAIN <br />�LCJR DRAIN <br />BACKF�OW PREVENTER <br />SINK (SERVICE.'�AR/MOP/ETC.) <br />OTHER __. ___ . <br />� ��2�1iC��Jt L <br />— —1 <br />NO. I n'PEOF�is��iqEORITEM <br />A/C — /UHANDLWG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UN�T HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIFEPLAC:E/STOVE <br />FIRF.PLACE INSERT <br />GAS FIHEPLACE <br />GAS fiANGE <br />GAS PIPING <br />EXHAUST FAN <br />� OTHER_ <br />I HEREBY CERITIFY'HAT I HAVE REAO 4ND E%AMINED TNIS APPLICATION AND KNOW THE SAME TO BE ?RUE AND CORRECT. ALL <br />PROVISIONS OF lAW$ APJD ORIpINACES GOVERNING iHIS ll'PE OF WORK WILL BE COMPLIED WITH WI'ETHER SPECIFIED HEREIN OF <br />NOT TH[ GRANTIN OF A PERMIT DOES NO PAESUh . TO GIVE AUTHORITY TO VIGLATE OR CANCEL fHE PFOVISION OF ANV OTHER <br />STATE OR LOCA AW REGULATING CON TION OR THE PERFOAMANCE OF CONSTRUCTION THI..* I AM AUTHORIZED BV THE <br />OWNER OF T PROPERTYYO PERFO E WORK FOR WHICH APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTFACT �`" W 1827 RCW AND . 0 WAC. <br />/%/�G� 1 � _ �� �-(� ` � l/�/�li� <br />� <br />