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P(.RMIT APPLICATIC V <br />4M77- CITY LF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257.8810 — FAX 425-257.8857 <br />SITE ADDRESS sr PARCEL TAX I.D. M PERMIT a <br />g �— p�nE� S 00 OGb01"t0 0 <br />LEGA LOT N0. BLOCK TRACT Q�/� Q ` <br />DESC 000 p-o D V A-�.41F� <br />OWNER ADDRESS ZIP PHONE <br />(IrJUw* t m C,f'/8 r P <br />TENANT NAME (CONTACT NAME PHONE <br />ONTRACTOR ADDRESS ZIP CONTP <br />-q (may 94 , GV&PZ�M1 L40 a g81aJy <br />I <br />PHUN` q->y Y) <br />51 <br />() I I <br />I <br />mvj"rJ►--1-j-1ry <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building <br />Combination <br />Mechanical <br />Plumbing <br />ff <br />WORK <br />Addition <br />Altaralion <br />MEAT SOURCE <br />Electric <br />N <br />Gas <br />�[� <br />R <br />TYPE <br />Demolition <br />Sprinkler <br />Sign <br />TYPE <br />New <br />Repan/Maint <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />CONTRACT PRICE OF WORK/ <br />_ <br />WORK DESCRIPTION <br />NO. <br />Z N ST I-4— 4r--lcl- CZN&Lt "Z(,fCr <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ 1 A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />_ { HEAT PUMP <br />_ UNIT HEATERS <br />_ (CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />_ METAL FIREPLACE/STOVE <br />_ FIREPLACE INSERT <br />_ GAS FIREPLACE <br />_ GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CErITIF', THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINU OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />REGULATINGSTATE OR LOCAL LAW <br />OWNER OF TTHIS PROPERTY OPER ORM THE WORK FOR WHICH APPLICATION FTION THAT I AM D DV THE <br />S MADE ANDI COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />