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PL�3MIT APPLICATIG�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 n' ) <br />— 7�--U-D-�-=�� <br />SITE ADDRESS PARCEL TAX I.D. Y PERMIT M <br />�% 7� S — �ia" c_ � , S�_ , I .:L 410s / :',rXX�.3. .Z 31K� I C� (vv � G2`1S <br />LOT N0. <br />.�' <br />TENANT NAME <br />BLOCK TRACT <br />y�u./ G�e.�,.�. <br />NAME <br />�� . <br />PHONE <br />S f,+-i`ti U S��, l7'_ �Zo,'tiA,�., � c/ z� —� 3;�. -6 z 7p <br />CONTRACTOR A�DRESS ZIP CONTR. LICENSE M <br />WFNAe�� yy� .�r c! <br />PHONE <br />i /97ti - <br />PROPOSED USE OF BUILOING <br />S� �/ <br />CONTRACT PFICE OF WORK <br />Bmlding <br />PEqM1T � Combina�ion <br />TYPE Demolilion <br />Sprinkler <br />WORK DESCHIPTION �3 ?S i c , �i <br />%�//! d//'/YiJ � <br />-- � , <br />I NO. � TYPE OF FI�TUHE G i ITEM <br />WAIEH GLOSEi <br />BA71�tUB <br />.S" LAVATORY (WASH BASIN) <br />� SHOWER <br />' KITCHEN SINK 8 DISPOSAL <br />/ DISHWASHER <br />� LAUNDFiV TRAY <br />/ CLOTHES WASHER <br />_� URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLCW PREVENTER <br />_ SINK (SERVICE/�AFVMOP/ETCJ <br />OTHER <br />RMechanlcal <br />Plum6ing <br />p Sign <br />�Additian <br />Allerallon <br />New <br />Fepair/Maint. <br />HEATSOURCE <br />D Electnc <br />�Cj Ges <br />�-� Olher <br />CITY OF EVERETT LOCAL $ALES TA% CODE IS 3105 <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />'HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIFEPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />O7HER <br />I HEFEBY CERITIFY'HAT I HAVE READ ANO EXAMINE� THIS APPUCATION AND KNOW THE $AME TO BE TFUE AND CORRECT. ALL <br />PROVISIONS OF 1�1WS QND ORIDINaCES GOVERNING THIS TVPF OF WCRK WILL BE COMPIIED WI?H WHETHER SPECIFIED HEREIN OR <br />N07 THE Gf7AN71NG OF A PERMI i DOES NOT PRESUME LG GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROViS10N OF ANY OTHER <br />STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE PERFORMANCE OF CG '�TFUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATIpN IS MALE AND I COMPLY WITH ThE .TATE <br />CONTRACTORS LAW �827 RCW AND 296200 WAC. <br />1/L <br />