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� <br />��ERMIT APPLICA�'"aN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-SS10 - FAX 425-257-8857 <br />SITE ADDRESS <br />��/Zy 1? �c � «.-- <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />�� /� v..�. C'. b(���,t <br />T�liL�S' s�/�'�a�z�+ <br />TENANT NAME <br />nn /� S� %�/�-n-w4:.� /�rn <br />PARCEL TAX I.D. # <br />TRACT <br />£��z_v ic/c / P9 � 3 i 7�,r. ic�.•:./y Lc's� <br />ICONTACTNAME <br />/lr,li.0 f�� �/zY• 8 <br />CONTRACTOR G�U �� � D��� �$ �U�ts �DRESS <br />H- <br />PHONE <br />%U.G 3 3y ' 70 67 �"Zs� -i3. ��ohe�� <br />PERMIT N <br />moa� <br />�✓"�7 l % JJ 7 — <br />PHONE <br />H�cti�•rret'Wt %S'�f� <br />ZIP CONTR. LICENSE q <br />PROPOSED USE OF BUIL�ING Building �Mechanical Addition HEAT SOURCE <br />PERMIT R Combination Plumbing WORK AI eralion Electric <br />TYPE D Demolilion Sign TYPE New as <br />U Sprinkler Fepair/Mainl. Olher <br />CONTRACT PRICE OF WORK ,Z�� ,t� CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />WORK OESCRIPTION 2,�,STy�Z (��,� L/,�S /ti 5� ��(� /3k y�cf �/3 $�G�IYF -f�``K��<7' e�GSCi <br />,_.�.5•—s�y. �`si�.��„ G�,c.� � cc�/Sa�,ic: r�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I _ SHOWER <br />� _ KITCHEN SINK 8 DISPO5AL <br />CISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICElBAWMOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C —A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIFEPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />� GAS PIPING <br />EXHAUST FAN <br />� OTHER Ci>ci ��ti� • <br />I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICAT�OIJ AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS OF L1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 6E COMPLIED WITH WHE7HER SPECIFIED HERcIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUlATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 0Y THE <br />OWNER OF THIS flTY TO PERFORM THE WORK FOR WHICH APPLICATI� N IS MADE AND I COh1PLY WITH THE STATE <br />CONTFACT __ W 18,27 RCW AND 29fi.200 WAG � <br />%� <br />