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r � � ' <br />, � PEI�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS PARCEL TAX I.D. M <br />a30� If`d��' ��o��'. S� Oo��.27�(-Vw-vs`s=o0 <br />DESC. � S S <br />Ca'ua�I'n�� �°rpon��/d1'� <br />TENANTNAME <br />CONTRACTOR �� Same a3 O W �¢r 4 <br />PHONE <br />I AODRESS <br />� �O ,Q4 X /10 ae//cVM� <br />CONTACT NAME <br />K4�rih0. /av�C— <br />I ADDRESS <br />P d'� � I I D-� O L!' <br />PERMiT • <br />�e�/Ia -o� <br />PHONE <br />�v�i )ys�=a�oo <br />PHONE <br />'�z1' ) �Y�' �LJl3 <br />CONTR. LICENSE N <br />��adKc�- z�z �oF <br />PROPOSED USE OF BUILDING I I�uilding � Mechanical I I�Atltli�ion I HEA�OURCE <br />PERMIT Combinatlon Plumbing WORK IUteratbn Eiectric <br />c�rR TYPE Demolition Sign TYPE New Gas <br />Sprinkler RepaiNMalnt. Other <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />Si�.J/t, 1 4w+il� � _ii�c..c� <br />�bi S S �oN�,r � 4G,RC� <br />N0. I TYFE OF FI)RURE OR ITEM <br />J WATERCLOSET <br />BATHTUB <br />LAVATOfiV (WASI' BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRV TRAY <br />�L CLOTHCS WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF ORAIN <br />BACKFLOW PREVENTER <br />� SINK (SERV�CEJBAR/MOP/ETC.) <br />OTHER <br />CITY OP EVERETT LOCAL SALES TAIC CODE IS 3105 <br />Bas�c �115� <br />NO. I TYPE OF Fl7CTUFE OH ITEM <br />A!C - AlHANDLIN6 UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />� RANGEHOOD <br />,� WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSFRT <br />GA3 FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />Z EXHAUST FAN <br />OTHER <br />I HEREBV CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAAIE TO BE TRUE ANU CORRECT. ALL <br />PFOVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COM1IPLIED WITM WHETNER SPECIFIED HERE�N OH <br />NOT-. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE CR CANCEL TME PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW FEGULATING CONGTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM nUTHORtZED BY THE <br />OWNER OF THIS PROPERT/ TO PERFORM THE WOFK FOR WNICH APPLICATION IS MADE ANJ I COMPLV WIiM THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />z <br />