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SITE ADGRESS <br />LOT NO. <br />TENANTNAME <br />P�RMIT APPLICATII,�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982n1 <br />425-257-8810 - FAX 425-257-8857 <br />' C e � BLOCK <br />U I�.e S <br />CONTRA OR <br />�V�i n e � �"S ��iSU <br />PHONE <br />C2oi,> 2�12-g <br />PROPOSED USE OF BUILDING <br />N/l� <br />PARCEL TAX I.D. � <br />�%�-i�n � oc� <br />TRACT <br />CONTACTNAME <br />�-r Z �c-K�.i� <br />PERMIT p <br />C�e12��— <br />�65 n � 00 <br />Q ADDRESS ZIP CONTR. LICENSE q <br />S�S-4e h�, S�iy �'� ��e S DwiNEv So�M2 <br />Building Mechanical <br />PERMI7 R Combination � Plumbing <br />TYPE D Demolilion Sign <br />U Sprinkler <br />CONTRACT PRICE OF WORK � Q�oOQ <br />v <br />�(((]]] Addilion I HEAT SOURCE <br />Alteralian � Electric <br />New Gas <br />FiepaidMaint Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />WORK DESCFIPTIrN �I 1 � A^� � IU� /� n , <br />Ih�� l � 2�e�S G�1ah r�e� 1l�ir j cir 1 C.� �� ��rUv v� <br />-FaS c� �. C I I) vh�v� a�, <br />NO. I TYPE OF FUCTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TR.�Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />� <br />N0. 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 />_ RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />_ FIREPLACE �NSERT <br />GAS FIREPLACE <br />_ GAS RANGE <br />_ GAS PIPIN� <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TH[ SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WI?H WHEfIiER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUTAT�NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT � A�d AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOflK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOHS LA 8.27 RCW AND 296.200,WAC� � I�' � <br />�n n <br />� i vi, uo , U <br />� _ , ���r�t��� <br />Signalur t Owner/Contractor/Authorized Agent Dale 1/� <br />