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( PERMIT APPLIC�C TION <br />Cl TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 � <br />�o,s � ITz <br />SITE ADDHESS /� PARCEL TAl( I.0.1 <br />_ 7S1`� �%7�0'� S� I Ul-'I'/t7-O!X> vy3 ov I�r72r1�-/b77 <br />1E0A1J L�� NQ I <br />DESC �t j <br />OWNER <br />!��✓�f!.�r�f 7`1ii� .T,�/G <br />TENANT NAME <br />CONTRACTOR <br />PMONE <br />PROPOSED USE Of BUILDINO <br />:s-r,c <br />CONTFACT PRICE OF WORK <br />WORK DESCRIPTION <br />j % %' I <br />��'�f/�' .1f��f3 <br />� <br />r <br />TYPE OF Fl%TURE ON REN <br />ELOCK <br />WA7ER CLOSET <br />BnTHTUB <br />LAVAtOFV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISPOSAL <br />DISHWASHEF <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOH DRAIN <br />BACNFIOW PREVENTER <br />SINK (SERVICE/BAF/MOP/ETC.) <br />OTHER <br />�GJ/iJ S( i� ( ��j J.�'�.�./ <br />!✓ �,�-....��� ���; <br />PERM!T <br />TYPE <br />NAME <br />�a/� <br />�Building <br />Combinalion <br />Demolilion <br />Sprinkler <br />n Mechanical <br />r-�5 Plumbing <br />D s�g� <br />PHONE <br />?s-��3°/ o� 7� <br />ZIP CONTR. LICENBE 1 <br />�6�-�r,��yi�K <br />�Addlllon <br />Alteretbn <br />New <br />Hapair/A' �inl. <br />HEATBOURCE <br />�Elsctrk <br />Oee <br />omer <br />CITY OF EVERETT LOCAL SALES TA% COOE IS �706 <br />NO. � TYpE OF Fl1fTURE OR ITEM <br />= A/C-A/HANDLIN6UNITS <br />_L FOFCED Alq SYSTEMS <br />_ HEA7PUMP <br />= UNIT HEATEFS <br />�CLOTHES ORYER <br />RANGE HOOD <br />�_ WATEF HEATER <br />— METAL FIREPLACE/STOVE <br />= FIREPLACE INSERT <br />OAS FIREPLACE <br />i OAS RANOE <br />�/ f3AS PIPING <br />,.;�_ EXHAUST FAN <br />_ OTHER <br />I MEREBv CERiTIFY THAT I HAVE READ AND EXAMINED THIS APPI.ICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L4W5 ANO ORIDINACES GOV cRNING THIS TVPE OF WORN WILL BE COMPLIED WITH WHETFIER SPECIFIEO HERE�N OR <br />NOT THE GAANTING OF A PERMIT DOES NO'( PRESUME TO OIVE AUTHORITY TO VIOUTE OR CANCEL THE PHOVISION GF ANY OTHEH <br />STATE OR �pCAL UW R[GVUTINO CONST�}UCTION OR THE PERfORMANCE OF CONSTRUCTION. TNAT I AM AUiHORIZED BY iME <br />OWNEfi�OF HIS PROPERTY TO PERFORM'.�HE WORK FOH WfiICH APPLICATION IS MAOE AND I COMPIV WITH THE STATE <br />CONT RS ��N 1B?7 9C AN 298.270 WAC. <br />� <br />� <br />/ ��l�1°i t _�C_ — .S -�� �� <br />S pnelu o wner/ onlroclor ulhodze penl ele i/ <br />2 <br />r <br />