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� <br />� <br />;ITE ADDRESS <br />�r�/n 41� <br />LEQA LOTNO. <br />DESC. ZZ <br />�'�RMIT APPLICAT(lN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257•8810 - FAX 425-257•8857 <br />BLOCK <br />PARCEL TAX I.D.1 <br />.�� . .,. � .� <br />(e� ��wf � k/. s'.!� /B/b .So, LK.f��.s �Fe� 9.�ZS�3 <br />TENANiNAME CO ACTNAME PHONE <br />� /�����s..L yz.s =3.��/- as�3 <br />CONTRACTOR ,/ f ./�., T*� AODRE85 <br />`�/ /.t#rf� N�• <br />PHONE . \ ��.. _ i <br />PROPOSED USE OF BUILDING <br />SF� <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />��� <br />��`G '� <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATOFY (WASH BASIN) <br />SHOWER <br />KITCNEN SINK d DISPOSAL <br />DISHWASHER <br />LAUNDRVTRAY <br />CI.OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEfl <br />SINK (SERVICE/BAFUMOP/ETC.) <br />OTHER <br />wlding � Mechenical <br />PERMIT Cam6ination Plumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />Z <br />ZIP CONTR. LICENSE / <br />'E�rltif�rvoyy,Q <br />�„nbn HEAT90URCE <br />Ita�atlon �ectrk <br />ew ea <br />Fepelr/Meinl. Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IB 7f05 <br />NO. I TYPE OF FIXTURE OR ITEM <br />—'�— <br />-L <br />AIC - A/HANDLIN6 UNITS <br />FOFiCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT �iEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />QAS f;ANGE <br />GAS PIPING <br />EXHAUST FAN <br />I HEREBY CEfiITIFY TNAT I HAVE READ ANU EXAM�VED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS ANO OPIDIN��CES GOVERNING lHIS TVPE OF WORK WILL BE COMPLIED WITH WHEfHEH SPF.CIFIED HEREIN OR <br />NOT TIiE GRnNTiNG OF n PERM�T DOES NOT PRE9UME 70 G�VE nUTHORITV 70 VIOLATE OR CANCEL THE PROVIS�ON OF ANV OTHER <br />STATE OR LOCAL LAW REGUUTING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />COON E OFORSy1yl 8�7rv T�p 200 WA�ORK F�OR � H�PLIC=TIOON IS MADE AND I COMPLY WITH THE STATC <br />Si 3 3 <br />'/z <br />