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SITE ADDRESS <br />ao Sr`� , <br />LEGA LOT NO. <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, � VERETT, 'JVA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />_��1,t1• <br />BLOCK I TRACT <br />PAHCEL TAX I.D. 1 <br />aean�ir . <br />G b a0 <br />� 1- — <br />C�FRSonI (o�, Po $cX 3oN' �lf)' `jSJ.? -r.� .�''• 77/b <br />TEIIANT NAME I CONTACT NAME PHONE <br />CONTRACTOR <br />C7c"Uc'RfOn� CLiJ$7. <br />PHONE <br />�/ir- ,�s(,- 77/6 <br />PROPOSED USE OF BUILDING <br />SwG�r' FN+nlul P�S. <br />CONTRACT PRICE OF WORK <br />ADUHESS <br />{.'0, Bc/c 30� Edf <br />Bullding Mechenical <br />PERMIT Cambinnlion Plumbing <br />TVPE Demo'lllon Sign <br />Sprinl.ler <br />ZIP CONTR. LICENSE M <br />5��a3 6c�ccErsoy9mE' <br />�Addition I HEAT SOURCE <br />Aliere�ion � Ele[trK <br />New Gas <br />Rapai�iMainL I Olher <br />CITV OF EVERE7T LOCAL SALES TA% CODE IS 71 U5 <br />WORKUESCRIPTION I�'��p� �� �"�N/ y8N �� �'��� <br />NevJ NoJs� � �� `9 <br />NO. I TYPE OF FIXTURE OR ITEhM <br />� WATER CLOSET <br />1 BATIiTUB <br />� LAVATORY (WASIi BASIN) <br />SHOWER <br />�_ KI7CHEN SINK 8 DISPOSAL <br />I DISHWASHER <br />LAUNDRYTRAY <br />_�_ CLOTH[S WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FIAOfi DRAIN <br />DACKFIOW PREVENTER <br />, _ SINK (S[RVICE/OAWMOP/[TC.) <br />— y <br />2/�'7 <br />N0. I TYPE OF FlI(TURE OR ITEM <br />A/C �- A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPL4CE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLArE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HERE�V CERIiiFY THAT � HAVE READ AN� EXAh11NED 7tiIS APPLICATION AND K�JOW THE SAME TO BF TRUE AND CO�'9ECT. ALL <br />PROVISIONS OF LAWS ANU ORIOINACES GOVERNING TNIS TVPE OF WORK W LI ^F COMPLIED WITH WHETHER SPECIFIE� NEREIN OR <br />IJOT. THE GfiANTING OF A PEf:611T DOES NOT PRESUME TO IiIVE AUTNORITY TO VIG: RTE OR CANCEL THE PROVISION OF ANY OiHER <br />STATE OR LOCAL I.AW FaEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONS"RUCTION. THAT I AM AUTHORIZED 8V THE <br />OWIJER OF THIS PROP[fiTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLI' WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC <br />��/t/•U Z <br />'la) <br />