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SITE AD�RESS <br />� l ���� <br />LEGA lOT N0. <br />DESC. ( 1 <br />TENANTNAME <br />CONTRACTOq ' <br />� <br />PMONE , ���9��� <br />PERMIT APPL.ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET;, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�c.�/% Il�f'l O� � 9G <br />BLOCN TRACT <br />� <br />/I ADDRE55 <br />1Q�/�Ye � <br />ICONTACT NAME <br />ADDAESS <br />PHOPOSED USE OF BUILDING <br />�l%U`� /C/i/rs/LS yUN1� <br />O <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />/��� � <br />PLUMBINI <br />NO. I TYPE OF FIXTURE OR REM <br />AXI.D.N <br />ono oi7 od <br />Building Mechanical <br />PERMIT R Combine�ion R Plumbing <br />TYPE D Demolitlon D Sign <br />D Sprinkler <br />21p <br />PEFiM1T k <br />� �,�I� � <br />PHONE <br />CONTR. LICENSE N <br />n AOdilion HEAT SOURCE <br />�-� Alteratlon n Electnc <br />� _� New R ';as <br />u RepeiUMaml. LJ Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />�, n././ -� S f�'� i�'3 J <br />� ; <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK S DISPOSAL <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICErBAR/MOP/ETC.) <br />OTHER_ _ <br />N0. � TYPE OF FIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPIACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACt <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBV CEPITIF'/ THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF l 4WS AN� ORIDINACES GOVERNING TH�S 1VPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTNORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL L4W qEGULATING CONSTRUCTION OR THE PERFOFIAANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8V THE <br />pWNEF; OF THIS PROPERIY 70 PERFORM TNE WOFK FO�' WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C01UFR�CTORS LAW 1827 qLly AND 296.200 WAC. <br />/ f� /�/�/ <br />..r'�i..: .J" ;'V -.G' � � i ' '/� �! ' v ='�% <br />Si nawre o OwnenComra i uAuthonzed Agent ale �/ <br />G <br />7/ <br />