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� ---- <br />� <br />� <br />� SITE AOORESS <br />I �: � 30 /�'�� <br />PE�sMIT APPLICATIO� <br />CI'TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9b201 <br />�25-257-88� J - FAX 425-257-8857 <br />c'� / vo ; i �-� �=) `i ;' no �'(� �U; <br />iLEGA LOT NO. <br />DESC i <br />OYINER <br />�� � <br />TENANTNAME <br />�- ___ . <br />II ,.LQNTRACTOR / <br />�.'_7/�/Hf/iYc� C�JraST <br />i7 <br />i PHONE <br />�5r— �4�k-/S.3'� <br />'� PflOPO5E0 USE OF BUILDING <br />�� %G . <br />BLOCK <br />PARCEL TAX I.D. M <br />CONTACTNAME <br />PCRlAT w I <br />i �� ? ` l`" � <br />���� I <br />PHUNE I <br />�G� -3 V��� <br />PHONE <br />� �� Li Q f �/ %l��H/c ('1 �T�..�`� Y A '/;l .y�s <br />n ACI7FE5 i �., i1P CO,�ITR. UCENSE N <br />• <br />�. �-',-,J. r=�C�x /�'/��J��✓'i�'jT- y��C� '. .. � <br />���y (,��� i-/4r+-,��, � <br />I CONTRACT PPICE OF WORK `���i <br />WORK DESCRNtION <br />C.0 G v � % �2.a�,� , <br />- - P�unneir <br />TVPE OF FI%TUiiE OR ITEM <br />WATER CL0567 <br />BATHTU9 <br />U1VA70RY (WASH �ASIN) <br />SiiOWEH <br />KI7CHEN SIP1K 3 DISPGS�IL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES W�SHER <br />UfiIN,4L <br />DRINKING FOUNTAItJ <br />FLOOR DRAIN <br />BACKFLOW PREV[NTf=R <br />SIPlK (SERVICE.6ARiMOP/ETC.) <br />OTNER________ <br />B uding Q Mechanical <br />PERMIT oinbinalioi� I) Plumbing WORK <br />TYPE Dt�:molilion ❑ Sign TYPE <br />Spnnkler <br />A�tlition HEAT SOURCE � <br />AlleraliM Electnc � <br />1�P�� � Gas i <br />Aepauidann Other — I <br />C:TY OF EVEFETT LOCAL SALES 7A% CODE IS 3f05 <br />S�-/G /_ Ls ���M/L � <br />c�- S%d�2� <br />l�« ���._ <br />NO. I TYP[ OF FI%7URE OR ITEM <br />A/C - NHANDLING Ut11T5 <br />� FORCED AIR SVSTEMS <br />_ HEA' PUMP <br />UNIT HEATERS <br />� CLOTHES ORYER <br />_f_ RANGc HOOD <br />�, WAiER HE�ITER <br />METAL FIRFPLACE/STOVE <br />FIFlEPLACE INSERT <br />� GAS FIHEPLACE <br />_� GAS RANGE <br />.� GA:i PIPING <br />��� EXHAUSTfAN <br />OTHER_ _ <br />I HFFEaV CERITIFY'HAT i HAVL FlEAD AND E?(PIAINED THIS AFPLICATION AND KNOW TME SPME TO BE TRUE AND COPPECT ALL � <br />PRGVISIONS CF LaWS ��ND OPIDINa::[S GOVEPNING TNIS Tl'PE OF WOFK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR I <br />NOT TME GRANTING Uf 4 PENhtli DOES N07 PR[SUPdE TO GIVE AUTHORITY TO VIOl�1TE OFl CANCEL THE PFOVISION OF ANV C'hER � <br />�7ATE OR LUCaI L�lV REGUUITING CONSiRUCTIJN OR THE PERFORMANGE JF CONSTRUCTION THAT I Ald AUTHCRIZED 0`: !HE <br />CWNEH UF THIS PHOPEPN TO P[PFORId THE WJRK FOfi WHICH APPIICATION IS 61ADE AND I COMPLY WITH TNE STATE i <br />C0�lTFAC i ORS LAW 1B 27 RCW AND 296 200 WA(: /-', <br />l� ]_ I I � <br />, S�gnaluro o� Owner/GonlraclonAidhonzed Ayenl a�e <br />' �C�a�z�S �` I <br />; - --- ----- ----- <br />