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SITE ADDRESS <br />�17'1 U - <br />P�RMIT APPLICATI� N <br />CITY OF EVERETT PERM17 SERVICES <br />3200 CEDAR STREET, EVEFE7T, WA 98201 <br />425-257-8870 - FAX 425•257-8857 <br />rc, S-I- S.C—. <br />BLO�:K <br />TENANT NAME <br />v�le a � u f� h�� <br />CONTRACTOR <br />PHONE <br />n..innr 11i. � �n � �.^ <br />PqOPOSED USE Of BUILDING <br />CONTRACT PHICE GF WORK <br />� <br />PARCEL TAX I.D. A <br />TiiACT <br />C yU � �. 2"`� S� <br />r <br />> so��-g� <br />CONTACTNAME PHONE <br />I�%len�qrl In ��i�� f �f 5-32 i''S Z� I <br />AD�RE59 LP CONTR. LICENSE 1 <br />Building Mochenical <br />PERMIT R{-1 Combinelion Plumbing <br />TYPE u Dernalitlon Sign <br />lJ Sprinkler <br />WORKDESCRIPTION ��PI�L�h� �(lppr'�vlc� <br />..1 <br />NO. I TYPE OF FI%TURE OR REM <br />WATER CLOSET <br />BATIiTUA <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRI'TRAY <br />CLOTHES WASHEh <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL�W PREVENTER <br />SINK (SEFVICE/BAR/MOP'� �C.) <br />OTNER <br />�Additlon <br />Altaralion <br />New <br />Fepeir/Me�nt. <br />HEAT SOURCE <br />�Elactric <br />Oes <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3tQ� <br />�,�y <br />N0. I TYPE OF FlXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SVSTEMS <br />HF.AT PUMP <br />UNIT HEATERS <br />CI.OTHES DRYER <br />RANGEHO00 <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLICE IIJSERT <br />GAS FIREPLACE <br />GAS RANOE <br />GAS PIPING <br />EXHAUST FAN <br />OTHEF <br />W � �tC)e <br />I HEFEBV CERITIFV THAT I HAVE REA� ANO E%AMINED , HIS APPLICATION AND KNOW TNE SaME TO NE TRUE AND CORRECT ALl <br />PROVISIONS OF LAWS AND OFIDINnCES GOVERNING TMIS iVPE OF WORK WILL BE COMPIiED WITM WHETMER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PR[SUME TO GIVE AUTNORITV TO VIOIATE OR CANCEL THE PROVISION OF ANV OTMER <br />STATE OR LOCAL LAW REGULA7ING CON.�iTRUr'TION OR THE PERFORAIANCE OF CCNSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM iHE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITM THE SiATE <br />CONTRp CTORS LAW 1B 2 W AND 298.200 WAC. <br />,�/, ��.�» „�.�. S�6�c2 <br />