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C ERMI�' APPLICAT�, JN <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE A�DRESS <br />'7r�Z5/ tsl/����-'u r,vr�y <br />LEGAIT LOT NO. 9LOCK <br />� (( LNZ1,�L„✓ <br />TENANT NAME <br />�{-�� u��i51L�, <br />PARCEL T/1X I.D.1t <br />TRACT <br />��y�- S� A�r J 5��, �,�r� °i�r��.f � <br />C������L �-�✓� <br />PHUNE <br />PROPOSED USE OF ElUILOING <br />��TA�L <br />CONTRACT PRlCE OF WORK �— <br />WOFK DESCRIPTI9N <br />C NTACTNAME <br />J �u N1l'a � � �.2_ <br />NIT k <br />2l0 "0/ Z <br />z �',- ��9- �z �9 <br />PHONE <br />—Z�v 7 c,�=�� �� <br />ADORESS 21P CONTH. LIGENSt n <br />JNC (oC,'��- ��'� �1u.r 5 s�� 1.r.iJ J�l�) C;,��'j%ia�'g �i� <br />Building Mechanical <br />PERMIT � Combination Plumbing <br />TYPE Demolilion Sign <br />Sprinkler <br />�a"ve«n � ���� rn�sc� ii �� � ��v�,ti� <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER C�OSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACI<FLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />TYPE <br />nuwuui i <br />�Iteration <br />New <br />Repair/�dainl. <br />(1CMt JVun�.c <br />�Elacvic <br />Gas <br />Other <br />CIT! OP EVERETT LOCAL SALES TAX COOE is a7w <br />NO. I TYPE OF FI,CfUf;E OR ITEM <br />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 FIREPLACC/STOVE <br />FIREPWCE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS P�PING <br />EXHAUSTFAN <br />OTHER <br />I HEFEBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATIUN ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LiWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE C01+1PLIED WITH WHETHER SF'ECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PER�dIT DOES NOT PRESUME TO GIVE AUTHORITY?O VIOIATE OR CANCEI THE PROVI310N OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OA THE PERFORMANCE OF CONSTRUCTION. THAT I Ald AUTHORIZED BY THE <br />OWN OF THIS PROPERTY TO PEflFORM THE WORK FOA WHICH APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br />CONT ACTOFS LAW 18.27 RCW AND 296.200 WAC. <br />'� 7 ' � D- j�—JG <br />��, �� ���� / � <br />)gnature ol vrneuContractovAuthorized Agent Date l a <br />