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SITE AD�RESS <br />'ll _ <br />LEGA LOT NO. <br />DES� <br />�1\� <br />CONTRACTOR <br />(, <br />PHONE ��(� 1\\C_ <br />1� 1 <br />PROPOSEU USE OF BUILDING <br />� <br />coNTRACT PRICE OF WOqK <br />WOqK DESCRIPTION <br />�' �� �� �� � � � �� �l <br />PERMIT APPLICATION <br />:ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wf, 98201 <br />425-257-8810 — FAX 425-257-6857 <br />PARCEL TAX I.D. N <br />�W• 00 yyjd�00IU3 <br />BLOCK 7RACT <br />�-�:(� ` C <br />ADDqE6S <br />�-2�L1 IC l �Y \ � �V � �\ <br />- IC6NTACT NAME /1 1�� <br />uN1-� �\J_\t'N LF �._�i2 � � '�' <br />ADDRESS <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />�� <br />WATEH CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHW�SHER <br />LAUNDRY TRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />�LOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />Buildinq Mechenical <br />PEqM1T Combinalion Plumbing <br />TVPE Demolition Sign <br />Spdnkler (x ol heem) <br />P MRN <br />Z00 �Q/ <br />�� <br />z�r �rHONe <br />��\ �1��`\"a-- <br />�-�.�X PNONE <br />� '�:��I-��93La 33C �,7�1a(� <br />ZIP CONTq. LICENSE M <br />CS�-DC\kO�jN�� <br />rkQ \�l a �-j_ <br />Addllion HEAT SOURCE <br />Altemtlon jj Electric <br />�New �q Cies <br />Repeir/AAelnt. LJ Other <br />CITY OF EVEP.ETT LOCAL SALE6 TAX CODE IR 9105 <br />NO. I TVpE OF FII(TURE OR ITEM <br />F�C — A/HANDLING UNITS <br />FORCED AIR SVSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIqEPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RAN6E <br />GAS PIPIN6 <br />EXHAUST FAN <br />OTFIER___ <br />1 H[REBY CERITIFY THAT I HAVF qEAD AND EXAMINED TIIIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF I.AWS �ND ORIUINACES GOVFRIlING THI6 TYPE OF WOfIK WILL PE COMPLIED WITH WHCTHER SPECIFIED HEHEIN OR <br />N07 THE GRANTING Of A PFRMIT DOES NOT PRESUME TO GIVE AUTHOqIN TO VIOLATE OR CANCFL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTIO�.'. TNAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPF:IITV TO PERFORM THE W(�RK FOR WHICH APP�ICAT�ON IS fAADE AND I COMPLY WITH Tl1E STATE <br />CON7RqCTORS LAW 7B 27 RCyJ AyD 296200 WAC <br />�� �/ • �u �, �_ J l � 2 �/ e /n �. <br />