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PFRMIT APPLICATI("� <br />CITY G� EVERETT PERMIT SERVICES <br />3200 CEDAH STREET, EVERETT, WA 98201 <br />425•257•8910 - FAX 425-257•8857 <br />SITE ADDRE55 J�. <br />1L /�� `/ / '�/ <br />LEGA LOT N0. <br />OESC. �� I <br />�r „ . .� ., <br />� <br />TENANTNAME <br />CONTRACTOR <br />��'"- - <br />^HONE <br />,; r . <br />��ROPOSED USE Of BUILOING <br />�:ONTRACT PRICE OF WORK <br />\YOFK DESCRIPiION <br />���, % -%�;ier,./,� <br />i <br />PARCEL TAY I.D. � <br />;� � c. ����1 i- c C c- i' � I r � <br />BLOCK TR11CT � <br />,, ��u� <br />�r_ �, i �; �., t l' � � <br />ADORESS ZIP <br />` �� �! . . l "✓. ���.._. �. (.�-./ <br />� <br />!. -�.. . v; h ri j�" i'; f <br />ICONTACT NAME <br />PERMR / <br />),C�'�/o1 -�,`) <br />�/J�, _; j�/ C `. 7 � <br />/�J'� /�� �-�"`�,(/I.,Y�✓ I�;. <br />A�DRE.^,S ZIp <br />Building Mechanical <br />PERMIT � Combinalion R Plumbing <br />TYPE > Demolition � Sign <br />Sprinkler <br />�rn/S,�r,� <br />N0. I TYPE OF FIXTURE OR RE9A <br />3 WATER CLOSET <br />�� BATHTUB <br />7 IAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK 8 DISPOSAL <br />� DISHWAS}iER <br />` LAUNDRY TRAY <br />T CLOTHES WASNER <br />I�RINAI <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICFJBAR/MOP;[TC.) <br />PHONE <br />' . ��/ C i / .) <br />CONTR. LICENSE I <br />/i �-„� �/�✓� ��r�/,c�K <br />AddiUon HEAT SOURCE <br />WORK Alleralion n Electric <br />7YPE �New .F� Gas <br />Rep�ir/Meinl. LJ Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� < �/ <br />4� /.di -I� � i' / <br />NO. I TYPE OF FIXTURE OR ITEM <br />! A/C - A/HANDIING UNITS <br />= FORCED AIFi SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />�_ CLOTHES DRYER <br />_[_ RANGEHOOD <br />L WATER HEATER <br />- META� FIREPLACElSTOVE <br />FIqEPLACE INSERT <br />Z GAS FIREPLACE <br />� GAS RANGE <br />? IiAS PIPING <br />_� EXHAUST FAN <br />OTHER <br />I HEREBV CEiiTIFV THAT 1 HAVE fiEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COHFECT. ALL <br />PROVISIONS OF �AWS AN� ORIDINACES GOVERNING THIS TV?E OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />N01 THE GRAN7ING OF A PERMI7 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR IOCAI LAW REGUUITING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORI2ED BY `HE <br />OWNER OF T11S PROPEfiTY TO PERFOf1M THE WOiiK FOR WHICH APPLICATION IS MADE ANO I COMPLV WITH THE STAiF <br />CONTRq��7li51.AW 18.27AGW AND 298200 WAG. <br />/i ,j �`�/,�r / �" -�-`� <br />S�gnal re o Owner/ ontractorlAuthonze Agent ale �/ \ <br />L � <br />