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SITE ADDRESS <br />� / (/2t� <br />LEGAL LOT NC. <br />`� C� � <br />TENANTNAME <br />P�r�MIT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.O. N <br />s• r-. # e «:�,r-r� � .2 <br />BLOCK TRAC1 <br />CONTACT NAME <br />na <br />a �> •� ., o <br />PERMIT w <br />Sd3o7- <br />2e� �G� <br />PNONE <br />CONTRACTON ���J�,Uq7pNAL Siej�1C�, ADORESS �Z��� ,�„{�,,, p� J,�, 21P CONTR. LICENSE M <br />. , -/ / �n k+9 %�'-ea,y <br />PHONE �[,Z f ._ �] �F ( �� rJ � Z�/V %���SCO�(f <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� <br />Buildiry Mechanical <br />PERMIT R Combinotion� Plumbing <br />TYPE � Demoli�ion Sign <br />Spnnklnr <br />� <br />Addilion I HEAT SOURCE <br />WORK� Alteratron n Eletltic <br />7YPE New K Gos <br />Repalr/Mainl. LJ Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />Z•(/Jj/�-C � X� [ c, �y/�.yj���j CHNNNI-1 L 2-7'J�/I,f o(� /`JOpG L T- <br />ON �C'9t Z` k'�+'J �✓/��P "a'�d � J�%Iz�.� � ot/ Tf/C=.I'T�(CC b tvq-L� <br />7Nl�l/ /N7v .S'Ti�'c.CTa/1i/L ��Jcza�.JlrT�,Qs' <br />TVPE OF FI%TURE OR ITEM <br />WATER CLOSE7 <br />BATH7UP <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHEF <br />LAUNDfiY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PPEVENTER <br />S�NK �SERVICE�BAF/MOPiETC.) <br />OTHER <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHESDRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STUVE <br />FIREPLACE INS[FiT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBV CERITIFV 'HAT I HAVE READ AND E?(AMINED iHIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIS1045 OF L1W5 4ND OR�DINACES GOVERNING 7HIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OP <br />NOT THE GRANTING OF A PER�dIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL 7HF PROVISION OF ANV OTHER <br />STATE OR LOCAL LPW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUC?ION. THAT I AM AUTHORI2ED BV THE <br />OWMEF OF iHIS PROPERTI TQ P�RFQRh�YHE WORH FOR WHICH APPLICATION IS MADE AND I COMP�V WITH THE STATE <br />CnNTRAfTnRS I AlV 1R 17•IRf�SV�SNn �6a odn wec <br />l <br />/�/d3 <br />�L <br />