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SITE ADDRESS <br />z�oy <br />LEGn LOT N0. <br />i l�raf <br />NAME <br />CO�ITRACTOR <br />� �� <br />PHONE <br />PROPOSED USE OF BUILOING <br />S��' <br />CONTRA('T PRICE OF WURN <br />F'�RMIT APPLICAT' 7N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257•8810 - FAl: 425-257-885 � <br />BLOCK <br />�/C <br />WOFK DESCIIIPTION <br />J�^ � <br />B�l.�'c � zz I 7 <br />oi ��uou <br />NO. I TVPE OF FI%TURE OR ITEM <br />� <br />WATER CLOSET <br />OATHTU� <br />LAVATORY (WASH BASIN� <br />SHOWER <br />KITCHCN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOH DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAR/MOP/ETC,) <br />OTHEP. <br />PERMIT <br />TYPE <br />PARCEL TAX I.D.1 <br />GJr SJin�wvt /!.� <br />CONTACTNAME <br />I ���� <br />AD�RESS <br />Bullding Mechanical <br />CombmnGon R Pl��inbing <br />Demolilion p Sign <br />S)rinkler <br />PEq►'IT N <br />�� �� -� �'- `.-� <br />� 1L L / J <br />21P PHONE <br />9B� yzs-33y-a.n3 <br />PHONE <br />� yzs �3y-os�3 <br />ZIP CONTR. LICENSE � <br />Lf6.A�f.voyy�PK <br />Addition HEAT SOUHCE <br />WORK Aiterauan I Electnc <br />TVPE � New � Gas <br />Fepei�/Meint �.� Olher <br />CI?Y OF EVERETT LOCAI SALES TAX CODE IS 9105 <br />NO. � TVPE OF FI%TUHE OR ITEM <br />-- WG–A/HANDLINGUNITS <br />�_ FORCED AIR SYSTEMS <br />= HEAT PUMP <br />— UNIT HEATERS <br />1_ CLOTHES DRYER <br />� FANGE FIOOD <br />� WAT[R HEATER <br />� METAL FIREPLACE/SiOVE <br />— FIFEPLACE INSEFT <br />� ^uAS FIREPLACE <br />� GAS RANGE <br />S_ GAS PIPING <br />.`� EXHAUST FAN <br />OTHEF <br />� <br />I HERE�Y CERITIFV THAi I HAVE FEAD AND FhAMINED TNIS APPLICATION AND NNOW THE SAME TO BE TRUE AN� CORRECT. ALL <br />PROV�SIONS OF LAWS AN� ORIDINACES GOVERNING THIS TVPE OF WOFN WILL BE COMPLIED WITH WHETHER SPECIFIED IIEREIN OR <br />NOT THE GfiANTING OF A P[RMIT DOES NOT PRESUME TO GNE AUTHORITY TO VIOLATE OR CANCEL THE PPOVISION OF ANV OTHER <br />STA7E OR LOCAI LAbV fiEGUL4TING CONSTRUCiION OR THE PERFOPMANCE OF CONSTRUCTION. THAT I AM AUiHOR12ED BV THE <br />OWNEFj..GF iF31S PROP[RN TO PERFORM THE WORK FOR WHICH APPUCATION IS MADE AND I COMPLY WITH THE STATE <br />CONi�7A��(�IqS L}V1f�iB 2;f�F:�iiND 296 200 WAC. <br />C.� —1 ��� <br />