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PERMIT APPLIC,� TION <br />�i fY QF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-9810 — FAX 425-257-8857 <br />��sc�1�i7 <br />SITE ADORESS PARCEL TAX I.D. • p�R � <br />1�1� 97� L st pol�/c7- oc�, czc�-ov I C�3o5--oa-,5' <br />LEOA LOT NO. BLOCK <br />oWsc.Q �� rna�✓,c(ilx-� ��1� <br />� <br />%i'.7> <br />TENANTNAME <br />CONTRACTOH <br />_x��iil,u <br />PHONE <br />PqOPOSED USE OF BUILDING <br />S! f � <br />CONTRACT PRICE Of WORK <br />....nn vca�.nm � wn <br />, �fr� <br />� <br />/%tSi� `��" ��� �> <br />NO. <br />_i_ <br />TYPE OF FI7CTURF OR REM <br />I WATER CLOSET <br />BA7HTUB <br />LAVATORY(WqSH BASIN) <br />SHOW[R <br />KITC!IEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CL07HFS WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PFiEVENTEFi <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NAME <br />PHONE <br />HzS=:7�y- os7 � <br />LP CONTp.UCEN9E/ <br />���f� .v�� yy,FK <br />n Building � Mechanical Aadition HEATSOURCE <br />PERMIT �} Combinalion Plumbing WORK � allerailon �n,.[ Elaetrk <br />TYPE D Demolitlon Sisn TYPE New �Q Oea <br />U Spnnkler RepeiriAAeinl. U pther <br />CITY OF EVERETT LOCAL SALE3 TAR COOE I9 �105 <br />NO. � TYpE OF FlXTURE OR ITEM <br />' w� - n/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYEF <br />RANGEHOOD <br />WATEFi HEATER <br />M�TAL FIREPLACE/STOVE <br />FIREPUICE INSERT <br />OAS FIREPLACE <br />OAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CEFITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIDIONS OF IAWS AND ORIOINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETFiER SPECIFIED MEREIN OH <br />NOT. THE GRANTINO OF A PEfiMl7 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOUTE OR CANCEL THE PROVISION OF ANV OTHER <br />StATE OR LOCAL UW REGUUTINO CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNEFj OF THIS PROPERTY TO.PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTtihCTORS �J11/V 18.27 RCW�AND 7�8.2pp yyAC. <br />.,� � �`�✓� � `�<----... � �/��+".� <br />